Restaurant And Drinking Places Occupational Privilege Tax - City Of Omaha - 2013
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1CITY OF OMAHA RESTAURANT AND DRINKING PLACES
OCCUPATIONAL PRIVILEGE TAX
EIN Number ____________________________________
Tax report for the month of _______, 20____
Use Supplemental form if you are reporting for more than one location under the same ID Number
LOCAL ADDRESS
MAILING ADDRESS
Business Name
__________________________
Name:
_________________________
Street Address:
__________________________
Address:
_________________________
Omaha, Nebraska
Zip: ______________________
City: __________
State: ________ Zip_________
Telephone # : ______________
Telephone # : ______________
Email address: ________________________
Email address: ________________________
Local Manager: ________________________
Contact Name: _____________________
TAX CALCULATION:
1. Total revenue received for taxable food,
beverage and/or catering during the month
2. Adjustment to Revenue of previously PAID Period,
(Attach explanation)
3. Net revenue subject to the tax
4. 2.5% Occupation tax per Ordinance #38791
(2.5% x amount on Line 3)
5. Less: Collection fee (2% x amount on Line 4)
6. Occupation tax due (Line 4 -Line 5)
* or total from Supplemental form(s)
Taxes are due the last day of the month following the reporting month and delinquent the next day.
Complete the next section if the tax is late:
7. Penalty (10% x amount paid after due date)
8. Interest (1% per month x amount due)
9. Total late fees and interest
10. Previous Period Occupation tax payment adjustment
11. Total Occupation tax and late fee due
Under the penalties provided by law, the person signing this form affirms that this is a complete
and accurate statement of the receipts and payments subject to the occupational privilege tax.
Sign Here: __________________________________
___________________________
Authorized Signature
Printed Name
Instructions:
Date
______________________
Please send this form and your remittance to:
CITY OF OMAHA
1819 FARNAM ST., RM. H-10
OMAHA, NE 68183
v050113
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