Sales And Use Tax Return - City Of Lakewood

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PHN 303-987-7630
CITY OF LAKEWOOD
REVENUE DIVISION
TDD 303-987-7057
PO BOX 17479
FAX 303-987-7662
DENVER, CO 80217
SALES AND USE TAX RETURN
--Select One--
TAXPAYER’S NAME AND ADDRESS
PERIOD:
DUE DATE:
--Select One--
# of full time employees ______
LICENSE #:
# of part time employees ______
(FROM LINE 4)
1
5A
.00
0
.00
GROSS SALES AND SERVICE
0
AMOUNT OF CITY SALES TAX:
$
X 3%
2A
5B
.00
0
.00
ADD: BAD DEBTS COLLECTED
HOTEL/MOTEL ACCOMMODATIONS TAX: $
X 3%
2B
5C
0
.00
TOTAL OF LINE 1 AND 2A
3A
6
.00
.00
NON-TAXABLE SERVICE SALES
ADD: EXCESS TAX COLLECTED:
SALES TO OTHER LICENSED
3B
7
.00
0
.00
TOTAL SALES TAX COLLECTED: ADD LINES 5A, 5B & LINE 6
DEALERS FOR RESALE
SALES SHIPPED OUT OF
3C
8
.00
LAKEWOOD
D
3D
9
.00
BAD DEBTS CHARGED OFF
E
D
TRADE-INS FOR TAXABLE
CITY USE TAX (FROM SCHEDULE B)
3E
.00
RESALE
U
10
0
.00
C
PURCHASES SUBJECT TO TAX:
$_________________________ X 3%
SALES OF GASOLINE AND
3F
.00
CIGARETTES
T
I
SALES TO GOV’T AND
3G
11
.00
.00
TOTAL TAX DUE ADD LINES 7 & 10
0
CHARITABLE ORG’S
O
N
IF FILED
3H
.00
.00
RETURNED GOODS
10% PENALTY
AFTER
MULTIPLY PENALTY
S
12
THE DUE
& INTEREST
DATE
BY LINE 11
3I
PRESCRIPTION DRUGS
.00
1.0% INTEREST PER MONTH
.00
ADD:
GROCERY FOOD SALES FOR
TOTAL TAX, PENALTY, AND INTEREST DUE
3J
13
.00
0
.00
HOME CONSUMPTION
ADD LINES 11 AND 12
PUBLIC IMPROVEMENT FEES
3K
.00
A. ADD: PRIOR PERIOD ADJUSTMENT
.00
(NON-TAXABLE PURCHASES)
14
3L
OTHER DEDUCTIONS
.00
B. DEDUCT: PRIOR PERIOD ADJUSTMENT
.00
TOTAL DEDUCTIONS OF LINES 3A through 3L
3
.00
0
ADD LINES 13, 14A & 14B
MAKE CHECK OR
15
.00
0
TOTAL DUE AND
MONEY ORDER PAYABLE TO:
TOTAL CITY NET TAXABLE SALES & SERVICE –
4
PAYABLE
0
.00
SUBTRACT LINE 3 (TOTAL DEDUCTIONS)
CITY OF LAKEWOOD
FROM LINE 2B
SCHEDULE B – CITY USE TAX
SCHEDULE C – CONSOLIDATED ACCOUNTS
This schedule is required in all cases in which the taxpayer files a consolidated return which includes sales made
The Lakewood Municipal Code imposes a tax upon the privilege of using, storing, or otherwise consuming tangible
at more than one location. It must be completely filled out and convey all information required in accordance with
property or taxable services purchased, rented or leased in the City of Lakewood.
the column headings. If additional space is needed attach schedule in same format.
TYPE OF COMMODITY
DATE OF
LICENSE
PERIOD’S NET
NAME OF VENDOR & ADDRESS
PURCHASE PRICE
BUSINESS ADDRESS
PERIOD’S TOTAL GROSS SALES
PURCHASED
PURCHASE
NUMBER
TAXABLE SALES
.00
.00
.00
.00
.00
.00
.00
.00
.00
.00
.00
.00
.00
.00
.00
.00
.00
.00
.00
.00
.00
LINE 10
LINE 1
LINE 4
TOTAL PURCHASE PRICE OF PROPERTY/SERVICE SUBJECT TO CITY USE TAX,
ENTER TOTAL HERE AND ABOVE
0
0
0
.00
.00
.00
ENTER TOTAL HERE AND ABOVE ON LINE 10
ON LINE 1 AND 4
NOTES
NEW BUSINESS DATE
1. If ownership has changed, give date of change
SHOW CHANGE OF OWNERSHIP, NAME AND/OR ADDRESS, ETC.
I HEREBY CERTIFY UNDER PENALTY OF PERJURY, THAT THE
STATEMENTS MADE HEREIN ARE, TO THE BEST OF MY
MO
DAY
YEAR
and new owner’s name.
KNOWLEDGE, TRUE AND CORRECT.
2. If business has been permanently terminated,
_______ BUSINESS ADDRESS
_______ MAILING ADDRESS
give termination date.
SIGNED:
3. If business location has changed give new
address.
_______________________________________________________________________
PHONE:
TERMINATION DATE
4. If this return includes sales for more than one
MO
DAY
YEAR
location, complete schedule “C”. Totals from
_______________________________________________________________________
TITLE:
consolidated breakdown in schedule “C” need to
be the same as line 1 and line 4 of the return.
DATE:
_______________________________________________________________________
Revised 10-2010
PRINT FORM
CLEAR FORM

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