Form Rd-106a - Instructions For Preparing And Filing Convention And Tourism Tax Return (Hotel/motel) Page 2

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Name:
EIN:
Period From ________________
Period To
RD-107A (Rev 11/04)
Worksheet and Instructions for completing Food Establishment Return (RD-107)
WORKSHEET MUST BE COMPLETED AND ATTACHED TO RETURN
Line 1
If this is a final return under this ownership, enter date business closed.
Line 2
"X" if this amends a previously submitted return for the same period.
Line 3
Enter total gross receipts - Food Sales
Line 4
Enter total gross receipts - Liquor Sales
Line 5
Enter gross receipts (line 3 plus line 4)
Line 6
Enter total adjustments - Itemize adjustments below; if none enter zero.
Itemized Adjustments
Less -
$
Less -
$
Less -
$
$
$
Total Adjustment (enter on line 6 of RD 107)
$
Line 7
Enter taxable sales (line 5 plus or minus line 6)
Line 8
Enter total tax due (2% of line 7)
Line 9
If return is filed and paid prior to due date, enter discount amount (2% of line 8)
Line 10
Enter tax due (line 8 minus line 9)
Line 11
If return is delinquent, enter amount of interest due (0.33% of line 10 per month)
Line 12
If return is delinquent, enter amount of penalty due (5% of line 10 per month, not to
exceed 25%).
Line 13
Enter amount of overpayment on previous returns(s).
Line 14
Enter amount due (line 10, 11, and 12 minus line 13).
Line 15
Enter amount paid.
MAKE CHECK PAYABLE CITY TREASURER
AND MAIL TO P. O. BOX 15623, KANSAS CITY, MISSOURI 64106-0623
(Please retain copies of your convention & tourism tax filings for at least one year from original date due)

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