Prepared Food & Beverage Tax Return - Mecklenburg County Office Of The Tax Collector
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1Office of the Tax Collector
MECKLENBURG COUNTY
P .O. Box 32728
Charlotte, N.C. 28232
(704) 336-6315
FAX # (704) 336-7602
PREPARED FOOD & BEVERAGE TAX RETURN
(TO BE FILED WITHIN 20 DAYS FROM THE CLOSE OF EACH MONTH)
PLEASE READ CAREFULLY INSTRUCTIONS PRINTED ON BACK FOR COMPLETING THIS FORM
Account Number
Social Security or Federal ID No. (Optional)
Business Phone Number
Street Address of Property
Owner of Business — Name
Address
COLUMN A
COLUMN B
Phone No.
SALES
TAX DUE
1. Gross Retail Receipts (Excluding Sales Tax)
$
2. Less: Non-Prepared Food/Beverage Receipts
$
3. Net Retail Prepared Food/Beverage Receipts
$
(Multiply Amount on Line 3 by Tax Rate of 1% and enter on line 4.)
4. Prepared Food/Beverage Tax Due:
$
5. Excess Tax Collected
$
6. Penalty Due: (See Instructions on Back)
$
7. Interest (See Instructions on Back)
$
8. PAST DUE BALANCE (SEE BELOW)
$
ADD LINES 4 THROUGH 8 AND ENTER HERE.
$
(Make Check Payable To: City-County Tax Collector)
IF NAME, ADDRESS, LOCATION HAS CHANGED - OR IF THIS IS A FINAL RETURN
PLEASE COMPLETE THE FOLLOWING:
Change of
Mailing
Location
Phone #
Trade
Ownership
Address
Address
Name
DATE SOLD
Please cancel my account as of
New Owner:
Reason must be indicated
CERTIFICATION: This is to certify that this report, including all statements and schedules attached hereto, has been examined by me,
and is, to the best of my knowledge and belief, a true and complete report made in good faith covering the month named above and that
same is in accordance with the records of the reporting taxpayer.
Date
Name - Please Print
Signature
THIS SPACE FOR TAX OFFICE USE ONLY
DATE RECEIVED
Return PM
AMOUNT RECEIVED
Payment PM
RECEIVED BY
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Parent category: Financial