Food And Beverage Tax Return Form - City Of Galena printable pdf download

Food And Beverage Tax Return Form - City Of Galena

, I

ITY OF

ALENA

LLINOIS

Food And Beverage Tax – Return Form

Return for the Month of: ____________________________ and Year of: ____________________________

Illinois Business Tax # (IBT): ___________________________________________________________________

Name of Business: __________________________________________________________________________

Address of Business: ________________________________________________________________________

Phone #: _____________________________________ Email: ______________________________________

Name Payee: ______________________________________________________________________________

Address of Payee

: _______________________________________________________

(if different than business address)

Phone #: _____________________________________ Email: ______________________________________

1. Total Sales Subject to Tax

2. Food and Beverage Tax

(Line 1 x 1%) $

3. If filed after due date, add 7.5% penalty*

(Line 2 x 7.5%) $

4. Interest payable if delinquent.

(Line 2 x 1.25% per month) $

5. Total Amount Due to City

(Line 2 + 3 + 4)

*Tax payment must be received not later than 4:30 p.m. at City Hall on the last City working day of the month

following the month the taxes were collected. The tax shall be paid to the City of Galena on a monthly basis.

Failure to accurately and timely report and remit the Amusement Tax may result in penalties, including, but

not limited to, revocation of Amusement Tax License, fines and legal proceedings.

The undersigned certifies that the information set forth in this return is true and accurate to the best of

his/her knowledge.

____________________________________________________

Signature

Title

Date

City of Galena Use Only

Date Received: ________________________________ Received By: ________________________________

License #: _________________________________________________________________________________

•

101 Green Street, P.O. Box 310

Galena, Illinois 61036

•

Telephone: 815-777-1050

Facsimile: 815-777-3083

Food And Beverage Tax Return Form - City Of Galena