Prepared Food And Beverage Tax Or Transient Lodging Tax Return Form - Bedford - Virginia

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CITY OF BEDFORD
PREPARED FOOD AND BEVERAGE TAX
OR TRANSIENT LODGING TAX RETURN
ACCOUNT #
TAXPAYER ID
LICENSE #
REPORT FOR
MONTH/YEAR
BUSINESS NAME AND ADDRESS:
OWNER NAME:
LOCATION:
TELEPHONE:
E-MAIL:
CONTACT NAME:
1. GROSS SALES SUBJECT TO TAX:
$__________________________
2. TAX DUE (5% LINE 1):
$__________________________
3. LESS TAX COLLECTION FEE:
$__________________________
(2% LINE 2, IF PAID BY DUE DATE)
4. ADJUSTMENTS FROM PRIOR MONTHS: $__________________________
(ATTACH EXPLANATION)
5. NET TAX DUE:
$___________________________
6. PENALTY LATE FILING (10% LINE 5
OR $10.00 WHICHEVER IS GREATER)
$___________________________
7. INTEREST (10% PER ANNUM)
$___________________________
8. TOTAL REMITTANCE
$___________________________
If payment is not made timely the tax collection fee (line3) is disallowed and a 10% penalty or $10.00
whichever is greater is charged. Interest is assessed 30 days after the due date by the Treasurer.
Under penalties provided by law, the undersigned certifies that this return is true and accurate to the best of his/her
knowledge and belief and is taken from the books and records of the business for which this return is filed.
____________________________________
____________________________________________
Signature
Title
Date
th
This return is due and payable on or before the 20
day of the month following the month taxes are
collected. Return this copy with payment made payable to the City of Bedford, P O Box 807, Bedford VA
24523. A penalty of 10%of the tax (minimum of $10.00) is imposed if not paid by the due date. The tax
collection fee is also disallowed on late returns. Should you cease business, please file that months tax
immediately listing the name of the successor on the return. Any questions should be directed to the
Commissioner of the Revenue, (540)587-6051.
Date:___________________________
Signed: _____________________________________
Commissioner of the Revenue
Date:__________________________
Signed:______________________________________
Treasurer
Please return this form with payment

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