Sales/use/lodging/device Tax Return Form - City Of Black Hawk
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1FILING PERIOD
DATES COVERED
DUE DATE
CITY LICENSE #
CITY OF BLACK HAWK
August
8/1/2017 - 8/31/2017
9/20/2017
SALES/USE/LODGING/DEVICE
COMPANY NAME AND ADDRESS
TAX RETURN
ATTN: FINANCE DEPARTMENT
PO BOX 68
BLACK HAWK, CO 80422
1
Gross receipts
from all City activities, including sales, rentals,
City sales tax
- 6% of Line 5
6
-
Excess tax
collected
leases, and all services both taxable and non-taxable
-
7
-
Lodging tax
2 Bad debts collected
-
8
-
x 2%
-
3
Total Receipts
Total tax due
- lines 6-9
Line 1 + Line 2
-
9
-
4
Allowable deductions
(select from drop-down list)
10 General device fees - Sched C
-
Select:
4a
11 Transportation device fees - Sched C
-
Select:
4b
12 Ambulance device fees - Sched C
0.00
Total device fees due
- lines 11-13
Select:
4c
13
-
Total tax and device fees due
- line 10 + line 14
Select:
4d
14
-
15 Late Filing Penalty - 10% of line 14 (minimum $15)
Select:
4e
16 Interest - 1.5% of line 14 (per month)
Other Deductions
4f
Description Of Other Deduction(s) :
17
Total tax, device fees penalty and interest due
-
18 Adjustments (attach support) + or -
4
Total deductions
Lines 4a through 4f
-
19 Adjustments (attach support) + or -
5
Net taxable
sales and service
Line 3 less Line 4
-
20
Total due and payable to the City of Black Hawk
-
SCHEDULE B LODGING TAX
SCHEDULE C DEVICE FEES
(CASINOS ONLY)
Total lodging sales
Device count
this month
Allowable deductions
Sales to gov't, religious, charitable entities
General Device Fee
Complimentary lodging
Monthly fee
$
87.50
=
-
Lodging sales >= 30 consecutive days
-
Rebate
$
(0.35)
=
-
General device fees due with this return
-
Total deductions
-
Transportation Device Fee
Monthly fee
$
4.28
=
-
Sched B -
Net taxable
lodging sales
-
Rebate
$
(0.02)
=
-
Transportation device fees due with this return
-
PREPARER CERTIFICATION
Ambulance Device Fee
Select:
(this return MUST be signed)
Monthly fee
$
2.50
=
0.00
City Clerk assigns a 4-digit business license number which is also used to file
and pay sales, lodging, and device tax returns. If you do not know the license
Signature
Date
number OR filing frequency for your business, please call 303-582-2294.
Printed Name
*
The Municipal Code imposes a use tax upon construction and building
materials - collected via the building permit process; and upon motor
Contact info: Telephone and Email
vehicles purchased at retail - collected at the time of vehicle registration.
Therefore, use tax should not be reported on this return.
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