City Of Dacono Sale And Use Tax Return Form

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City of Dacono – Sale and Use Tax Return
Business name and address: _____________________________________
City Code: __________ Reporting period : _________________
LINE
DETAIL
DOLLARS
CENTS
1
GROSS SALES AND SERVICES
2
ADD BAD DEBTS COLLECTED
3
TOTAL LINES 1 & 2 – Add lines 1 & 2
4A
NON-TAXABLE SERVICE SALES
4B
SALES TO OTHER LICENSED DEALERS FOR TAXABLE RESALE
4C
SALES SHIPPED OUT OF CITY OR STATE
4D
BAD DEBTS CHARGE OFF
4E
TRADE-INS FOR TAXABLE RESALE
4F
SALES OF GASOLINE AND CIGARETTES
4G
SALES TO GOV’T, RELIGIOUS, AND CHARITABLE ORG
4H
RETURNED GOODS
4I
PRESCRIPTION DRUGS AND PROSTHETIC DEVICES
4J
OTHER
4K
OTHER
4L
OTHER
4M
OTHER
4Z
TOTAL DEDUCTIONS – Total Lines: 4a thru 4M
TOTAL CITY NET TAXABLE SALES AND SERVICE – Subtract Line 4Z from
5
Line 3
6
AMOUNT OF CITY SALES TAX DUE – Line 5 times Sales Tax Rate
7
ADD EXCESS TAX COLLECTED
8
ADJUSTED CITY TAX – Add Lines: 6 and 7
9
VENDOR FEE @ 3.33% – Vendor fee is .0333 times line 8 (Not to exceed $100)
10
TOTAL TAX – Subtract line 9 from 8
11A
VALUE SUBJECT TO USE TAX
11B
USE TAX DUE – Line 11A times Use Tax Rate of 3%
11C
TOTAL SALES AND USE TAX DUE – Add Lines: 10 and 11B
12A
LATE FILE PENALTY – 10% OF LINE 11C – If late then multiply: Line 11C
times 10%
12B
LATE FILING INTEREST (1% PER MONTH OF LINE 11C) – If the return is
late, multiply line 11C by 1% for each month the return is late
TOTAL TAXES, PENALTY, AND INTEREST – Add Lines: 11C, 12A, and 12B
13
14
ADD PRIOR ADJUSTMENTS (DEBIT) – Add prior positive amounts due
15
DEDUCT PRIOR ADJUSTMENTS (CREDIT) – Deduct prior credits
16
TOTAL DUE AND TAXABLE – Add Lines: 13, 14 and subtract: Line 15 Min.
0.00
PAYMENT
PAYMENT RECEIVED
I HEREBY CERTIFY UNDER PENALTY OF PERJURY, THAT THE STATEMENTS MADE HEREIN ARE TO THE
BEST OF MY KNOWLEDGE TRUE AND CORRECT.
X
SIGN HERE
PRINTED NAME
TITLE
DATE
Please remit to: City of Dacono, Attn: Sales Tax, 512 Cherry St., PO Box 186, Dacono, CO 80514

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