Food & Beverage Tax Return Form - City Of Thomasville - 2011

City of Thomasville, AL

Food & Beverage Tax Return

Remit To:

Tax Division

P.O. Box 830725

Birmingham, AL 35283-0725

(800) 556-7274

Amount of Check Enclosed:

$

__________________________________________

th

Mail by the 15

, Delinquent after the 20th

Please do not staple checks to form

.

(

Make Check Payable To: Tax Trust Account)

RDS Account #:

Please Mark the Period you are Filing on This Return. Filing for Tax Period :

Jan

Feb

Mar

Apr

May

June

July

Aug

Sept

Oct

Nov

Dec Year: 20_____

—USE THIS FORM FOR TAX PERIODS AUGUST 2010 AND FOLLOWING.—

The City of Thomasville levies an additional 1% license or privilege tax on food service establishments. The license or privilege tax is

equal to one (1%) percent of the gross income of sales (at retail) of food, refreshments or beverages sold for consumption, which

th

of the month for the preceding month’s report of

requires a Board of Health permit. Tax levied is due and payable on or before the 20

income. Any person who fails to comply with the provisions of this levy shall, upon conviction, be punished by a fine not less than $1.00

and no more than $500.00. In addition, such person may be sentenced to jail or hard labor for the City of Thomasville, AL for a period

not to exceed six (6) months. Each violation shall be deemed a separate offense.

Instructions: Multiply Gross Income by the applicable tax rate to calculate the net tax due.

Tax

Jur

Jurisdiction

Gross Income

Tax

Net Tax Due

Type

Tax Rate Code

Code

Name

Rate

Code

9405

Thomasville

45

11

$

1%

$

Food and Beverages

Total Due

*Please see Thomasville Alcohol Beverage Tax form to remit Tax due for the Sale of Beer, Wine, and other Alcoholic Beverages. Form

is available at .

I declare, under penalties of perjury, that this return (and any accompanying schedules) has been examined by me and to the best of my knowledge is

true, correct and complete.

Taxpayer’s Signature____________________________________________________ Date:_____________________FEIN:_____________________

Print Taxpayer’s Name:__________________________________________________Telephone:___________________________________________

Paid Preparer’s Signature________________________________________________ Print Paid Preparer’s Name______________________________

FORM DISCLAIMER:

Please note that the administration and rate changes on the RDS Advisory and RDS tax forms are updated once the required information has been received, verified, and validated in compliance

with RDS policy. Any information received before or after the publication of an RDS Advisory or tax form will not be guaranteed to appear on said forms until all such requirements have been met. RDS is not responsible for

incorrect information and/or improper use of the information provided. All updates are completed on a timely basis once the requirements have been met. For the most current RDS administration and/or rate information

provided, please visit our website at

RETURNED CHECK DISCLAIMER: When you make a payment by check, you authorize us to use information from your check to make a one-time electronic fund transfer from your checking account according to the

terms of your check or to process that transaction as a check. When we use your check to make an electronic fund transfer, funds may be withdrawn from your checking account the same day we receive your payment,

and you will not receive your check back from your financial institution. If there are insufficient funds in your checking account, you authorize us to charge a Returned Payment Fee in the amount set forth below and collect

that amount through an electronic fund transfer from your checking account, if permitted by applicable law. IF YOUR CHECK OR OTHER PAYMENT IS RETURNED UNPAID by your bank, we may, if permitted by

applicable law, charge a Returned Payment Fee of $ 50 in KY and VA; $40 in DE and MS; $ 35 in MD; $30 in AL, OH, SC, TN, and TX; $25 in AR, IL, MO, NC and WV; $20 in IN; the greater of 5% of the check or (i) $30 in

GA or (ii) $25 in LA; the greater of 5% of the check or (i) $25 if the check is under $50, (ii) $30 if the check is between $50 and $300 or (iii) $40 if the check is over $300 in FL. Effective July 1, 2010, each returned item

received by RDS due to insufficient funds will be electronically represented to the presenters’ bank no more than two times in an effort to obtain payment. RDS is not responsible for any additional bank fees that will accrue

due to the resubmission of the returned item.

Thomasville Food Tax

Updated 10/2011