Gross Receipts Tax Monthly Report - Conway Advertising & Promotion Commission
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1
2Conway Advertising & Promotion Commission
Gross Receipts Tax Monthly Report
Read Enclosed Instructions
This report must be received by Conway A & P Commission on/
or before the 20
th
day of the month (otherwise add penalty as instructed)
A & P Tax Permit No.
Issued by City:
__________________________________________________________
Business Name:
__________________________________________________________
Owner’s Name:
__________________________________________________________
Address:
__________________________________________________________
City
State
Zip
Payment for the month of ______________________, Year ______________
(Each month must be reported separately. Report must be filed even if NO tax is due.)
Taxable Gross Receipts
$ ___________________
Tax (2% of gross)
$___________________
Less 2% of tax
$ ___________________
th
(If paid by the 20
of the month)
Total
$ ___________________
th
Penalty (5% after the 30
day of the month)
$ ___________________
Total Tax Due
$ ___________________
Make checks payable to Conway A & P Commission and mail or hand deliver to:
By Mail:
In Person:
Conway A & P Commission
OR
Centennial Bank – Main Office
PO Box 1404
620 Chestnut
Conway, AR 72033-1404
Conway, AR 72032
I hereby state, avow, and affirm that the statements here are full, true, and correct as required by provisions of Ark. Code Ann. 26-75-601 and City
Ordinance No. O-05-142, such regulations promulgated thereunder by the Conway Advertising & Promotion Commission.
_______________________
________________________________________
Date Prepared
Signature of Owner, Officer, or Authorized Agent
COMMENTS OR QUESTIONS PLEASE CONTACT:
Lisa Stephens Certified Public Accountant, PLC
Michael O. Garrett, Conway City Clerk
OR
715 Front Street
Conway City Hall
Conway, AR 72032
(501) 450-6100
(501) 327-2834
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