COUNTY OF LOS ANGELES
TREASURER AND TAX COLLECTOR
UTILITY USER TAX
MONTHLY COMPUTATION FORM
MARK J. SALADINO
TREASURER AND TAX COLLECTOR
_________________
____________
______
Account Number
For the Month of:
Year:
_________________
___________________________
Company Name
Due Date:
______________________
Address:
Service Supplier Type. Check whichever applies:
______________________
Electric Service Supplier
______________________
Gas Service Supplier
Communications Service Supplier
__________________
Total Tax Amount Paid:
Your check must accompany this form. If you have any questions regarding this form, please call the Utility
User Tax Unit at (213) 893-7984, Monday-Friday 8 am to 4 pm PT or e-mail us at uut@ttc.lacounty.gov.
Fill in the information below to report and compute the amount due.
1. Total Utility Fee charges for taxable service(s)
1.
2. Less: Total exemptions
2.
3. Net taxable Utility Fee charges (Line 1 less Line 2)
3.
4. Total tax due (4.5% multiplied by net taxable Utility Fee charges) Line 3 x 4.5%
4.
5. Add penalty (15% of total tax due amount), if paid after due date. Line 4 x 15%
5.
6. Add interest (1.5% per month multiplied by total tax due until paid), if paid after due date.
6.
7. Less: Credit previously authorized in writing by Treasurer and Tax Collector (attach
7.
supporting documents)
8. Total amount due and payable (Total of Lines 4, 5, 6 and minus Line 7)
8.
Make checks payable to and mail to:
Los Angeles County Treasurer and Tax Collector
P.O. Box 30909
Los Angeles, CA 90030-0909
I HEREBY CERTIFY UNDER PENALTY OF PERJURY THAT THE INFORMATION IN THIS FORM IS
TRUE AND CORRECT.
__________________________________________
Signature
Date: _______________________
__________________________________________
______________
Print Name
Title ______
(___) ______________
(___) _______________
______________________
Telephone
Fax
E-mail
The Los Angeles County Utility User Tax is codified in Title 4, Chapter 4.62 of the Los Angeles County Code.
Refer to
(Revised 11/09)
1
