PRINCE GEORGE COUNTY
COMMISSIONER OF THE REVENUE
Darlene M. Rowsey
P.O. BOX 155
Commissioner of the Revenue
PRINCE GEORGE, VA 23875
(804) 722-8740
MAKE CHECKS PAYABLE TO: PRINCE GEORGE TREASURER
MEALS TAX REMITTANCE FORM
ACCOUNT #:
OWNER:
DBA
:
ADDRESS:
CITY/STATE/ZIP:
TH
TAXES MUST BE REPORTED AND SUBMITTED BY THE 20
OF THE MONTH FOLLOWING THE
MONTH OF COLLECTION. A RETURN MUST BE FILED FOR THE REQUIRED PERIOD
REGARDLESS OF WHETHER ANY TAX IS DUE.
FOR THE MONTH OF: ________________________________
GROSS MEAL RECEIPTS:
$___________________
4% TAX ON MEALS:
___________________
LESS DISCOUNT 3% OF TAX*:
___________________
TAX DUE:
___________________
PENALTY**:
___________________
INTEREST:
___________________
TOTAL DUE:
___________________
I hereby certify that the figures shown on this form are in accordance with the code of the
County of Prince George, Virginia.
___________________________________________________
__________________
SIGNED
DATE
*Discount allowed only if payment received by due date.
**6% per month, maximum 30%, minimum $10.00
VALID ONLY FOR AMOUNT RECEIPTED BY TREASURER
____________________________ ___________________
RECEIVED BY
DATE
REVENUE CODE: 10-31287
Office Use Only:
Date Received: _____________
Late: _____ Waived Penalty: _______
Staff Initials: ________
Cash: ______ Check #: _____________ Credit/Debit: ______
Bill Number: ________