SALES TAX NUMBER:
COMPLETE THIS SECTION ONLY IF THIS IS A FINAL RETURN
Date Business Discontinued ______________________Reason Business Discontinued _____________________________________
Name and Address of Purchaser _________________________________________________________________________________
FOR OFFICE USE ONLY
Date received _____________________ By ____________________ If Mailed, Postmark Date _____________________________
Cash ______________________ Check Number _______________ Amount Remitted: ____________________________________
CITY OF THORNE BAY
P.O. BOX 19110
THORNE BAY, ALASKA 9991