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                                                                                                                            City of Westminster
                                                Request for Certificate of Taxes Due                                        Department of Finance
                                                                                                                            Sales Tax Division
                                                                 Please Type or Print Clearly
                                    1) Legal Name of Business or Individual Name (Last, First):

                                    2) Trade Name of Business (if any):

                                    3) Mailing Address:                                                                 7) Contact Person (if Business):

                                    4) City:                                                 5) State:     6) Zip:      8) Phone Number:

                                    E-mail Address:                                                                     9) City Account Number:

                          This form must be filled out completely in order for your request to be processed.
         In most cases, a Certificate of Taxes Due will be issued within 2 business days. There is no fee for this certificate.

10) Certification of Requestor:     I, the undersigned, hereby certify that I am the ____________________________ (title) of the above-
referenced taxpayer and am duly authorized under § 38-25.5-101(1) of the Colorado Revised Statutes, and § 4-1-12(A)(2) of the Westminster 
Municipal Code  to request this tax information.

11) Furnish completed certificate to:                                       12) Method of Transmittal:
                Taxpayer listed above                                                      Send via U.S. mail.
                Other party listed on line 13 below                                        Personal service at City Hall.

13) Party to receive completed Certificate (if different from taxpayer):

                 a) Legal Name of Business or Individual Name (Last, First):

                 b) Attention/Care Of:

                 c) Mailing Address:

                 d) City:                                        e) State:  f) Zip:

14) Is this certificate requested in conjunction with a sale/transfer of the business listed on line 1 above?
                Yes (complete lines 15 through 18 below)
                No
15) Closing Date                    16) Purchase Price (total)                               17) Personal Property Price

                                    $                                                        $

18) Has the transferee agreed to remit the Westminster sales and use taxes due on the transfer within 10 days?
                Yes, tax will be remitted by transferee on the Initial Use Tax Return.
                No, tax will be collected by the tranferor and remitted to the City within 10 days of closing.

                          Under penalty of perjury, I declare that I have examined this Request for Certificate of Taxes Due and that the same is true and correct to the best of
                          my knowledge and belief. I hereby warrant and guarantee that I am fully authorized to make this request on behalf of the Taxpayer.

Taxpayer
                          Signature                                                                                     Date
Signature

                          Printed Name                                      Title                                       Phone No.
Return completed form to:           Westminster Department of Finance   Sales Tax Division   4800 W 92nd Avenue   Westminster,CO 80031
                                    (303) 658-2065   Fax: (303) 706-3923  http://www.cityofwestminster.us



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               Instructions for Request for Certificate of Taxes Due 
                                                                       
General Instructions                                                   Line  10  –  Certification  of  requestor. The Westminster 
                                                                       Municipal  Code  (“Code”)  permits  the  City  to  release 
                                                                       confidential tax information        to  duly     authorized 
Purpose of Form                                                        representatives of the taxpayer. Similarly, § 38-25.5-102 of 
                                                                       the Colorado  Revised  Statutes  authorizes  the  release  of 
This form is used for taxpayers to request a Certificate of            confidential  tax  information  to  certain  authorized  persons 
Taxes  Due  (“CTD”).  A  CTD  certifies  the  amount  of  any          (See § 38-25.5-101(1) C.R.S.).  
outstanding total tax liability and certifies that the taxpayer         
has filed all returns due as of the date it is issued. A CTD is        Print the title of the person completing the request.  
typically  requested  by  a  taxpayer  quitting  business  who          
wishes to certify to potential buyers that taxes are current           If the CTD is requested by an authorized person other than 
with the City.                                                         the  taxpayer,  evidence  of  such  authorization  must  be 
                                                                       submitted with the request. 
The City of Westminster does not charge a fee to obtain a               
CTD. The completed CTD will typically be available in two              Line  11  –  Completed  CTD  issuance.         Check  the 
business days and can be issued to the taxpayer or directly            appropriate box to indicate whether to issue the completed 
to a potential buyer.                                                  CTD  to  the  taxpayer,  or  the  party  listed  on  lines  13  a 
                                                                       through f. If neither box is checked, the completed CTD will 
For  additional  information  regarding  Certificates  of  Taxes       be issued to the taxpayer. 
Due  or  business  purchases,  refer  to   Tax  Compliance              
Guide topics 334 and 357 respectively.                                 Line 12 – Method of transmittal. Check the appropriate to 
                                                                       indicate whether to mail the completed CTD or serve it in 
Reminders                                                              person  at  City  Hall.  Proper  photo  identification  will  be 
                                                                       required. If neither box is checked, the completed CTD will 
Taxpayer  request  required.  Because  certain  tax                    be mailed. 
information is confidential, only the taxpayer can request a            
CTD.  The  completed  CTD  can  be  issued  directly  to  a            Line  13  –  Third  party  recipient  information. Print  the 
potential buyer at the taxpayer’s request.                             legal  name,  attention  or  care  of  (if  any)  and  mailing 
                                                                       address for the party to receive the completed CTD. If the 
Subsequent  returns  must  be  filed.        Returns  due              completed  CTD  will  be  issued  to  the  taxpayer,  this  line 
subsequent  to  the  issuance  of  a  CTD  must  be  filed  and        need not be completed. 
payment must be remitted by the taxpayer.                               
                                                                       Line  14  – Pending  sale/transfer. If the request  is made 
Tax liability is lien upon property.   Any outstanding total           pursuant  to a pending transfer of assets by the taxpayer, 
tax liability, whether or not it is listed in the CTD, is a lien       check ‘Yes’ and complete lines 15 through 18. Otherwise, 
upon the property of the taxpayer which may be acquired.               check ‘No’ and complete the signature block. 
Purchasers  are  required  to  obtain  a  CTD  and  a  receipt          
showing the taxes have been paid by the seller or withhold             Line  15  –  Closing  date. Enter  the  date  (or  approximate 
from the purchase money an amount sufficient to cover the              date) upon which the transfer will be completed. 
total tax liability certified therein.                                  
                                                                       Line 16 – Purchase price. Enter the gross purchase price 
Tax  due  upon  transfer. In  addition  to  the  outstanding           of all assets, including all property tangible and intangible, 
liability of the seller, sales and use taxes will be due upon          real and personal, which will be acquired in the transfer. 
the  transfer  transaction  even  though  the  seller  may  have        
previously  paid  sales  or  use  taxes  upon  the  purchase  of       Line  17  –  Personal  property  price. Enter  the  amount 
the  property  sold.  This  may  be  true  even  for  non-cash         included  on  line  16  which  applies  to  tangible  personal 
transactions.                                                          property.  
                                                                        
Signature  required.  The  person  completing  the  request            Line  18  –  Tax  remittance  responsibility.  Check  the 
on behalf of the taxpayer must sign and date the form at               appropriate  box  to  indicate  whether  the  seller  will  collect 
the bottom. A printed name is also required. If the taxpayer           the  tax  upon  the  transfer  and  remit  it  to  the  City  or  the 
is  not  a  natural  person,  the  title  of  the  officer  or  agent  buyer will remit the tax to the City. This line relates to taxes 
completing the form on behalf of the taxpayer must also be             due upon the transfer, not to the total tax liability listed in 
printed on the form.                                                   the CTD. 
                                                                        
                                                                                    Pursuant to the Code, both the buyer and the 
Specific Instructions                                                               seller are jointly and severally liable for the tax 
                                                                                    due  from  the  transfer.  An  agreement  among 
Lines  1  thru  8  –  Taxpayer  information.  Print  the  legal                     the parties regarding the taxes due upon the 
name, the trade or other name the taxpayer is known as,                             transfer  will  not  limit  the  City’s  ability  to 
the  mailing  address,  contact  person’s  name,  and  phone           demand payment from either party. 
number  of  the  taxpayer.  For  declarations  of  natural              
persons  or  sole  proprietorships,  print  the  last  name            Signature  – After  reviewing  the  form  for  accuracy,  sign 
followed by the first name on line 1.                                  and  date  the  form.  Print  your  name  and  title  below  your 
                                                                       signature. Return the form to the Westminster Department 
Line  9  –  City  account  number.  List  the  7  digit  City  of      of Finance. 
Westminster account number.                                             
 






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