Tax Return Prepared Food & Beverage Tax - Mecklenburg County - 2013
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1
2City – County Tax Collector
Due Date:
Account #:
For the month of
Mecklenburg County
P.O. Box 32728 Charlotte, NC 28232
Ph#: (704) 336-7600
Fax#: (704) 336-7602
TAX RETURN
PREPARED FOOD & BEVERAGE TAX
th
Must be filed on or before the twentieth (20
) day of each month following the month in which the tax accrues.
Please carefully read the instructions printed on the back before completing this return.
Account Number
Social Security or Federal ID Number (optional)
Street Address of Property:
Business Contact:
Contact Telephone Number:
Email Address:
Column A
Column B
Computation of Prepared Food & Beverage Tax
Sales
Tax Due
1. Gross retail receipts (excluding sales tax)
$
2. Less: non-prepared food/beverage receipts
$
3. Net retail prepared food/beverage receipts (subtract line 2 from line 1)
$
4. Prepared Food/Beverage Tax due (multiply line 3 by 1%)
$
5. Penalty due - filed after due date (multiply line 4 by 5% per month; 25%
maximum)
$
6. Penalty due - paid after due date (multiply line 4 by 10%)
$
7. Interest (multiply line 4 by 0.75% per month)
$
8. Past due balance (see below)
$
9. Excess tax collected
$
10. Total due (add lines 4 through 9)
(
make check payable to: City-County Tax Collector)
$
Please complete the following regarding any changes to this account.
Location address
Change of ownership
Please explain and attach documentation (i.e., Bill of Sale):
Mailing address
Trade name
Telephone number
Date sold
/
/
Other
Date closed
/
/
Certification: I hereby certify that I have examined this return. To the best of my knowledge and belief, this is a true and complete
return submitted in good faith covering the month specified. This return is in accordance with the records of the reporting taxpayer.
Date: ________________ Name: (please print) ____________________________ Signature: ___________________________
TAXPAYER ALERTS APPEAR BELOW
PAID DATE
POSTED DATE
FILED DATE
RECEIVED BY
AMOUNT RECEIVED
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