City Of Martinsville Prepared Food And Beverage Tax Return Form

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CITY OF MARTINSVILLE
PREPARED FOOD AND BEVERAGE TAX RETURN
LICENSE NO.
Under penalties of 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.
MONTH
BILL NO.
Signature
Title
Date
NAME
TRADE NAME
ADDRESS 1
ADDRESS 2
CITY STATE ZIP
1. GROSS SALES OF PREPARED FOOD AND BEVERAGES
$
2. ALLOWABLE DEDUCTIONS
3. TAXABLE SALES (LINE 1 MINUS LINE 2)
4. TAX DUE (6.5% OF LINE 3)
5. SELLER’S DISCOUNT (3% OF LINE 4 IF REMITTED BY DUE DATE)
6. NET TAX DUE
7. PENALTIES (LATE FILING)
8. PRIOR BALANCE DUE *
9. TOTAL DUE
$
INSTRUCTIONS FOR FILING
th
This return is due on or before the 20
of each month following the month in which the tax on prepared food and beverage is made. State
statutes and the City of Martinsville Code provide for late payment and late filing penalties. A filing will be considered timely when the
gross receipts are reported and accompanied by remittance by the due date.
* If the form shows a prior balance due, add that amount to your check. If the prior balance due is a credit (-), deduct this
amount from your check.
Make checks payable to: City of Martinsville Treasurer
Remit report and payment to: Ruth L. Easley, Commissioner of the Revenue
P. O. Box 1222
Martinsville VA 24114-1122
IF FINAL RETURN PLEASE INDICATE: BUSINESS SOLD OR DISCONTINUED ON _____________
Date
Any seller going out of business shall
New Owner’s Name
immediately report and remit any tax due.
Failure to report and remit tax will result in
New Owner’s Residence Address
legal action.
Former Owner’s Residence Address
Effective September 1, 2012

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