Food And Beverage Tax Form
ADVERTISEMENT
1FO
OOD AN
ND BEVE
VERAGE
E TAX
CO
OUNTY OF HE
ENRICO, VIRG
GINIA
D
EPARTMENT
OF FINANCE
1. Gr
ross Sales
$_____
____________
___
(8
804) 501‐7354
4 or (804) 501
1‐7329
2. No
on‐ Taxable S
Sales and Oth
er Deduction
ns
$_____
____________
___
3. Ta
axable Sales
$_____
____________
___
(L
Line 1 less Line
e 2)
Collection
ns for the Per
riod Ending:
4. Fo
ood and Beve
rage Tax
$_____
____________
___
(Line
e 3 X 4%)
5. Se
eller’s Commi
ssion
$_____
____________
___
(Line 4 X
X 3%)
___________
________________
____________
Account N
Number
(only i
f the return is filed
d and the tax paid
d in full by the due
e date)
Name & A
Address
6. Su
ubtotal
$_____
____________
___
(Line 4
4 less Line 5)
7. Pe
enalty for Late
e Filing
$_____
____________
___
(Line 6
6 X 10%)
8. Pe
enalty for Late
e Payment
$_____
____________
___
[(L
Lines 6 + 7) X 1
10%]
9. Su
um of Lines 6,
, 7, and 8
$_____
____________
___
10. In
nterest if Late
e
$_____
____________
___
(Line 9 X a da
ily rate of .027
74%)
I declare tha
at the forgoing s
statements are t
true, full and cor
rrect
11. To
otal Due
$_____
____________
___
(Line
e 9 + Line 10)
to the best o
of my knowledg
e.
12. A
mount Paid
$_____
____________
___
________
____________
___________
____________
___
th
Signature
Dat
te
Due b
by the 20
day o
of the month fo
llowing the end
d of the reportin
ng period.
________
____________
____
___
___________
____
Mail T
To: County of H
Henrico, Lockbox
x #4733, P O Box
x 90791, Henric
co, VA 23228‐07
791
Title
Pho
one
Rev 1/
14 SL
FOOD
D AND
BEVER
RAGE TA
AX
C
COUNTY OF H
ENRICO, VIRG
GINIA
D
DEPARTMENT
T OF FINANCE
E
1. Gr
ross Sales
$_____
____________
___
(8
804) 501‐7354
4 or (804) 501
1‐7329
2. No
on‐ Taxable S
Sales and Oth
er Deduction
ns $_____
____________
___
3. Ta
axable Sales
$_____
____________
___
(L
Line 1 less Line
e 2)
Collection
ns for the Per
riod Ending:
4. Fo
ood and Beve
rage Tax
$_____
____________
___
(Line
e 3 X 4%)
5. Se
eller’s Commi
ssion
$_____
____________
___
(Line 4 X
X 3%)
___________
________________
____________
Account N
Number
(only i
f the return is filed
d and the tax paid
d in full by the due
e date)
Name & A
Address
6. Su
ubtotal
$_____
____________
___
(Line 4
4 less Line 5)
7. Pe
enalty for Late
e Filing
$_____
____________
___
(Line 6
6 X 10%)
8. Pe
enalty for Late
e Payment
$_____
____________
___
[(L
Lines 6 + 7) X 1
10%]
9. Su
um of Lines 6,
, 7, and 8
$_____
____________
___
10. In
terest if Late
$_____
____________
___
(Line 9 X a dai
ily rate of .027
74%)
I declare tha
at the forgoing s
statements are t
true, full and cor
rrect
11. To
otal Due
$_____
____________
___
(Line
e 9 + Line 10)
to the best o
of my knowledg
e.
12. A
mount Paid
$_____
____________
___
________
____________
___________
____________
___
th
Signature
Dat
te
Due b
by the 20
day o
of the month fo
llowing the end
d of the reportin
ng period.
________
____________
____
___
___________
____
Mail T
To: County of H
Henrico, Lockbox
x #4733, P O Box
x 90791, Henric
co, VA 23228‐07
791
Title
Pho
one
Rev 1/
14 SL
FOOD
D AND
BEVER
RAGE TA
AX
C
COUNTY OF H
HENRICO, VIR
RGINIA
D
DEPARTMENT
T OF FINANCE
E
1. Gr
ross Sales
$_____
____________
___
(
(804) 501‐735
54 or (804) 50
01‐7329
2. No
on‐ Taxable S
Sales and Oth
er Deduction
ns $_____
____________
___
3. Ta
axable Sales
$_____
____________
___
(L
Line 1 less Line
e 2)
Collection
ns for the Per
riod Ending:
4. Fo
ood and Beve
rage Tax
$_____
____________
___
(Line
e 3 X 4%)
5. Se
eller’s Commi
ssion
$_____
____________
___
(Line 4 X
X 3%)
___________
________________
____________
Account N
Number
(only i
f the return is filed
d and the tax paid
d in full by the due
e date)
Name & A
Address
6. Su
ubtotal
$_____
____________
___
(Line 4
4 less Line 5)
7. Pe
enalty for Late
e Filing
$_____
____________
___
(Line 6
6 X 10%)
8. Pe
enalty for Late
e Payment
$_____
____________
___
[(L
Lines 6 + 7) X 1
10%]
9. Su
um of Lines 6,
, 7, and 8
$_____
____________
___
10. In
terest if Late
$_____
____________
___
(Line 9 X a dai
ily rate of .027
74%)
I declare tha
at the forgoing s
statements are t
true, full and cor
rrect
11. To
otal Due
$_____
____________
___
(Line
e 9 + Line 10)
to the best o
of my knowledg
e.
12. A
mount Paid
$_____
____________
___
________
____________
___________
____________
___
th
Signature
Dat
te
Due b
by the 20
day o
of the month fo
llowing the end
d of the reportin
ng period.
________
____________
____
___
___________
____
Mail T
To: County of H
Henrico, Lockbox
x #4733, P O Box
x 90791, Henric
co, VA 23228‐07
791
Title
Pho
one
Rev 1/
14 SL
ADVERTISEMENT
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