Annual Reconciliation Of Liquor Tax - City Of Philadelphia

Annual Reconciliation Of Liquor Tax - City Of Philadelphia - 2002

MAKE NO MARKS IN THIS AREA

City of Philadelphia

2 8 0 2

Due Date: February 28, 2003

2002 Annual Reconciliation

of Liquor Tax

City Account Number

Print name:

Federal Identification Number

Address:

Social Security Number

If your business terminated, had a change of address, or a change of entity, use the Change Form.

Failure to file a return by the due date could result in the imposition of fines and legal costs.

. 0 0

1. Total Gross Receipts - All Sales Receipts (1/1/2002 - 12/31/2002).........1.

2. Total Exclusions (Sales Receipts not subject to Liquor Sales Tax)

. 0 0

a. Food.................................................................................2a.

. 0 0

b. Other................................................................................2b.

. 0 0

c. Total Exclusions (2a plus 2b)...........................................2c.

. 0 0

3. Taxable Liquor Sales Receipts (Line 1 minus Line 2C)...........................3.

. 0 0

4. Total Tax Due (Line 3 X 10%)..................................................................4.

. 0 0

5. Tax previously paid for 2002....................................................................5.

. 0 0

6. If Line 4 is greater than Line 5, enter TAX DUE.......................................6.

. 0 0

7. If Line 5 is greater than Line 4, enter TAX OVERPAID............................7.

Under penalties of perjury, as set forth in 18 Pa. C.S. §§ 4902-4903 as amended, I, a person required under § 19-1507 of the Philadelphia Code

to collect, truthfully Account for, and pay over any tax due under this return, swear that I have reviewed this return and accompanying statements

and schedules, and to the best of my knowledge and belief, they are true and complete.

Taxpayer Signature_______________________________________ Date________________ Phone #____________________

Preparer Signature_______________________________________ Date________________ Phone #____________________

MAIL TO: PHILADELPHIA REVENUE DEPARTMENT

P.O. BOX 1670

PHILADELPHIA, PA 19105-1670

QUESTIONS: 215-686-6600

E-mail: revenue@phila.gov

Annual Reconciliation Of Liquor Tax - City Of Philadelphia - 2002