Form Ez - Payroll Tax Statement - 2005
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12005 EZ FORM PAYROLL TAX STATEMENT
DELINQUENT AFTER FEBRUARY 28, 2006
BUSINESS TAX ID NUMBER
CERTIFICATE NUM BER
TAX YEAR
BUSINESS LOCATION
2005
DO NOT WRITE IN PRE-PRINTED AREAS. USE BLACK INK AND STAY INSIDE BOXES.
PLEASE HAND PRINT. DO NOT TYPE. DO NOT SEND PHOTOCOPY.
Number of taxable San Francisco
Final Statement
Date closed/sold___________
employees as of 12/31/05:
If sold, name, address, and phone number of new owner:
Neighborhood Beautification Fund Designation
___________________________________
___________________________________
(_______)___________________________
Complete this form only if your 2005 taxable
San Francisco payroll was $66,666.34 or
more, or you are claiming a refund, or this is
a final statement. Otherwise, complete and
return the Business Registration Renewal
only.
-
-
CONTACT NUMBER
,
,
,
.
$
Total PAYROLL EXPENSE
1.
,
,
,
.
$
2.
Total EXEMPT PAYROLL
$
Total Taxable San Francisco Payroll (Subtract line 2 from line 1)
3.
,
,
,
.
4.
$
Payroll Tax Calculated (Multiply line 3 by Payroll Tax rate of 1.5% or .015)
If line 4 is less than $1,000.00, complete and return the Registration Renewal only unless claiming a refund or filing a final statement.
5.
$
6.
If line 4 is over $2,500.00 enter the amount from line 4, otherwise, enter zero, and complete lines 7 to 14.
$
7.
Enter 2005 PREPAYMENT PAID (Do not include Registration Fees). If none, enter zero.
$
8.
Amount due. (Subtract line 7 from line 6. If line 7 is larger than line 6, enter zero).
,
,
$
.
9.
Amount to be refunded to you.
(If line 7 is larger than line 6, enter difference). See instruction booklet.
$
10.
If filed or postmarked after February 28, 2006, enter LATE FILING PENALTY. See instruction booklet.
$
11.
If paid after February 28, 2006, enter LATE PAYMENT PENALTY. See instruction booklet.
$
12.
If paid after February 28, 2006, enter INTEREST. See instruction booklet.
13.
$
If filed or postmarked after February 28, 2006, enter ADMINISTRATIVE FEE of $35.00.
14.
TOTAL DUE.
(Add Lines 8,10,11,12,13). Make check payable to San Francisco Tax Collector.
$
Under the laws of the State of California, I declare under penalty of perjury that I have read the foregoing and that it is true,
53641
correct, and complete to the best of my knowledge and belief.
X
DATE
B143-05
SIGN HERE
THIS STATEMENT MUST BE FILED BY FEBRUARY 28, 2006 OR YOU WILL BE SUBJECT TO FEES, PENALTIES, AND/OR INTEREST.
PLEASE DO NOT TEAR APART HERE
SAN FRANCISCO TAX COLLECTOR
2005 EZ
BUSINESS TAX SECTION
P.O. BOX 7425
SAN FRANCISCO, CA 94120-7425
PAYROLL TAX STATEMENT
TAXPAYER ASSISTANCE: (415) 554-4400 TTY: (415) 554-4455
PERIOD COVERED:
January 1 - December 31, 2005
DELINQUENT IF PAID OR POSTMARKED AFTER FEBRUARY 28, 2006
BUSINESS TAX ID NUMBER
OWNERSHIP NAME
PAYMENT ENCLOSED
NOTE: Payment enclosed must equal the amount due on Line 14.
OVER
(Please write your Business Tax ID or certificate number on your check.)
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