Excise Tax Return - Miami-Dade County Finance Department

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EXCISE TAX RETURN
MIAMI-DADE COUNTY
1
UNINCORPORATED DADE RECEIPTS
FINANCE DEPARTMENT
(TOTAL SALES FOR COLLECTION PERIOD)
TAX COLLECTION DIVISION
2
EXEMPTED RECEIPTS
(PER FLORIDA STATUTES)
Collection Period
3
TAXABLE RECEIPTS
Return and payment due by
(SUBTRACT LINE 2 FROM LINE 1 AND ENTER)
4
TAX BILLED
(ENTER AMOUNT OF TAX PER
I HEREBY CERTIFY THAT I have the authority to execute and file return, that I have
INSTRUCTIONS)
examined and am familiar with its contents and the records from which they were
5
TAX COLLECTED
secured and that this is true and complete, to the best of my knowledge and belief.
(ENTER AMOUNT OF TAX
COLLECTED THIS PERIOD)
6
LESS: COLLECTION ALLOWANCE
0.00
PREPARER’S SIGNATURE
DATE
(1% OF LINE 5, ONLY TELECOMMUNICATIONS)
7
NET TAX
PRINT NAME
TELEPHONE
(SUBTRACT LINE 6 FROM LINE 5 AND ENTER)
8
PLUS: PENALTY
(1% OF LINE 5, TIMES NUMBER OF
DELINQUENT MONTHS)
OFFICER’S SIGNATURE
9
TOTAL FOR THIS PERIOD
(ADD LINES 7 AND 8 AND ENTER)
PRINT NAME
In accordance with the provision of the Dade County Code, Sec 29-36 through 29-42
as amended, the seller filing this return entered the amount of tax stated on this form
upon invoices rendered to customers made in the unincorporated area of Miami-
Dade County during the month covered by this return, and remits herewith the
amount of such tax as shown hereon.
The company provides or supplies:
(Enter percentage)
NAME/ADDRESS CHANGE
% WATER
NAME:
% ELECTRICITY
ADDRESS:
% FUEL OIL
CITY:
% OTHER
STATE:
ZIP:
Send this form in the enclosed envelope
107.01-1206/98
Along with your check payable to:
DADE COUNTY TAX COLLECTOR
140 West Flagler St., Room 1208
Miami, FL 33130 Phone (305) 375-5228

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