Colorado Sales Tax Returns Form - 2000 Page 4

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4/18/99
303 123-4567
Date
Phone (
)
Signed under penalty of perjury in the second degree. Signature
Name
GROCERIES R US
•
(1-4)
00
1. Gross Sales and Services (include bad debts, previously deducted) ......
9247
Due
•
(2-4)
00
4/20/99
0
2. Deductions: a. Sales to other licensed dealers, for resale ...........
17
Date
00
Acct.
Period
21-67792
1/99-3/99
20-100
131
b. Other deductions (itemized on reverse side) ........
No.
00
c. Total (add lines 2a & 2b) .............
131
00
00
00
00
3. Net sales: (line 1 minus line 2C) ..........
9116
9116
9116
9116
00
00
00
00
a. Sales out of taxing area ...................
210
210
00
00
00
00
b. Exemptions (list on back) ................
6027
6027
00
00
00
00
c. Overpayment from previous return ..
•
(4-2)
(4-3)
(4-1)
00
00
00
(4-4)
00
4. Net taxable sales(line 3 minus a,b,& c) ..
8906
8906
3089
3089
TAX RATE
.0050
.0300
.0080
.0300
00
00
00
00
5. Amount of sales tax .............................
45
267
25
93
•
(6-1)
(6-3)
(6-2)
00
(6-4)
00
00
00
6. Excess tax collected .............................
0
0
0
0
00
00
00
00
7. Total (add lines 5 & 6) ..........................
25
45
267
93
8. a. Service fee rate ...............................
.0333
.0333
.0333
.0333
b. Service fee allowed vendor
•
(8-2)
(8-3)
(8-4)
(8-1)
00
00
00
00
2
9
1
3
(only if paid on or before due date) ..................
00
00
00
00
9. Sales tax due (line 7 minus line 8B) ....
43
258
24
90
300
•
(10-2)
(10-3)
(10-4)
(10-1)
00
00
00
00
10. Tax on $ ______________ ..................
9
2
9
2
(11-2)
(11-1)
00
(11-3)
00
(11-4)
00
00
11. Total tax due (add lines 9 & 10) .... (100)
267
26
99
45
12. Penalty: 0.10 times line 11 ............ (200)
(12-1)
(12-2)
00
(12-3)
(12-4)
00
00
00
13. Monthly prime interest rate
(13-1)
(13-2)
00
(13-3)
(13-4)
00
00
00
times line 11 .................................. (300)
00
00
00
00
26
45
267
99
14. Total each tax (add lines 11, 12, & 13) ..
00
15. TOTAL AMOUNT REMITTED make checks payable to the Colorado Department of Revenue .................... (355)
$
437
Paid by EFT
For detailed information concerning this example of a completed return see inside back cover.
'99 retail sales coupon bk
11
2/8/00, 7:54 AM

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