City Sales Tax #  __________________
Vendor Name ______________________________________                                                                                       P. O. Box 4000
Address, City State Zip  ______________________________                                                                               Sterling, CO 80751
               __________________________________________                                                                               (970) 522-9700
                                                                                                                                    FAX (970) 521-0632
Period End Date ________________  Due 20th of next month                                                     Sales / Use Tax Return

 1.  Gross Sales and Services              .     .     .     .     .     .     .     .     .     .     .     .     .     .     .     .     .     .
 2.  Add:  Bad Debts Collected             .     .     .     .     .     .     .     .     .     .     .     .     .     .     .     .     .     .
 3.  Total Lines 1 + 2                     .     .     .     .     .     .     .     .     .     .     .     .     .     .     .     .     .     .
 4.  Deductions:
     A.  Non-Taxable Service Sales (included in Line 1)    .     .     .
     B.  Sales to Other Dealers for Resale           .     .     .     .     .
     C.  Sales Shipped Out of City         .     .     .     .     .     .     .     .
     D.  Bad Debts Charged Off             .     .     .     .     .     .     .     .
     E.  Trade-Ins for Taxable Resale       .     .  .     .     .     .     .
     F.  Sales of Gasoline and Cigarettes       .    .     .     .     .     .
     G.  Sales to Government, Religious, Charitable   .     .     .     .
     H.  Returned Goods                    .     .     .     .     .     .     .     .
     I.   Prescription Drugs               .     .     .     .     .     .     .     .
     J.  Other (must be identified)  ________________________
     K.  _____________________________________________                                                                                             
     L.  _____________________________________________
                  Total Deductions (Lines 4A thru 4L)      .     .     .     .         .     .     .     .     .     .     .     .     .     .
 5.  Net Taxable Sales & Services (Line 3 less "Total Deductions")  .     .     .     .     .     .     .     .     .     .
 6.  Amount of City Tax:  3% (0.03) of Line 5             .     .     .     .          .     .     .     .     .     .     .     .     .     .
 7.  Add:  Excess Tax Collected                 .     .     .     .     .     .     .      .     .     .     .     .     .     .     .     .     .
 8.  Total Sales Tax (Line 6 + Line 7)      .     .     .     .     .     .     .     .     .     .     .     .     .     .     .     .     .
 9.  Amount Subject to Use Tax  $ ________________________          Times 3.0% of that (x 0.03)
10.  If Return is filed or Total Tax is paid after Due Date, add Penalty + Interest:
    A. Penalty: 10% (0.10) of Lines 8 + 9  .     .     .     .     .     .
    B. Interest: 1% (0.01) of Lines 8 + 9 per month or any portion
                  Total Penalty & Interest           .     .     .     .     .     .     .     .     .     .     .     .     .     .     .
11.  Total Tax, Penalty & Interest (Lines 8 + 9 + "Total Penalty & Interest")  .     .     .     .     .     .     .     .
12.  Add:  Underpayment on Prior Return              .     .     .     .     .     .     .     .     .     .     .     .     .     .     .
13.  Deduct:  Overpayment on Prior Return            .     .     .     .     .     .     .     .     .     .     .     .     .     .     .
14.  Total Due and Payable (Lines 11 + 12 - Line 13)     .     .     .     .     .     .     .     .     .     .     .     .     .

                                           (Please make check or money order payable to "City of Sterling.")                          

                                                                                        New business name, address, phone number, and/or owner:
          _____     Check here for permanent business closure.
          _____     Check here for change of address.
          _____     Check here for change of ownership.

Date of change:     ____________________________

I certify under penalty of perjury that the statements made hereon are to the best of my knowledge true and correct.

Signature:                                                                                     Phone:

Company:                                                                                       Date:

                           WHITE COPY: Return to Finance Department.                                              YELLOW COPY: Keep for your records.