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                                                                CITY OF ARVADA                                                                    CITY OF ARVADA 
                                                                                                                                                  Tax & Audit Division
     SCHEDULE            - A                          SALES & USE                TAX RETURN                                                       �8�1�0�1� �R�a�l�s�t�o�n� �R�o�a�d 
                                                                                                                                                  Arvada, Colorado 8000�2 
PERIOD                             DUE                            ACCOUNT                                                                             �7�2�0�-�8�9�8�-�7�1�0�0 
COVERED                            DATE                           NUMBER 
1.   GROSS SALES AND SERVICE          (TOTAL RECEIPTS FROM CITY ACTIVITY MUST BE REPORTED AND ACCOUNTED FOR IN EVERY RETURN INCL. ALL SALES,
                                      RENTALS, AND LEASES AND ALL SERVICES BOTH TAXABLE AND NON-TAXABLE)
2A.  ADD: BAD DEBTS  COLLECTED
2B.  TOTAL LINES 1 & 2A                                                                                                                     TOTAL 
3.  A   NON-TAXABLE SERVICE    SALES                       (INCLUDED     IN ITEM 1)                                                         A 
    B   SALES TO OTHER LICENSED DEALERS      FOR PURPOSES OF TAXABLE RESALE                                                                 B
D   C   SALES SHIPPED    OUT OF CITY AND/OR  STATE         (INCLUDED     IN ITEM 1)                                                         C 
E   D   BAD DEBTS CHARGED     OFF               (ON WHICH CITY SALES       TAX HAS BEEN PAID)                                               D 
D 
    E   TRADE INS FOR    RESALE                                                                                                             E 
U 
C   F   SALES OF GASOLINE    AND CIGARETTES                                                                                                 F 
T   G   SALES TO GOVERNMENTAL, RELIGIOUS       AND CHARITABLE ORGANIZATIONS                                                                 G 
I   H   RETURNED   GOODS                                                                                                                    H 
O   I   PRESCRIPTION DRUGS/PROSTHETIC       DEVICES                                                                                         I
N   J   OTHER DEDUCTIONS (ATTACH     EXPLANATION)                                                                                           J 
S 
3.   TOTAL DEDUCTIONS                                                                     (Total of Lines 3A thru 3J)                       TOTAL
4.   TOTAL CITY NET TAXABLE  SALES & SERVICE                                       (Line 2B MINUS TOTAL        LINE 3) 
                                                                         COMPUTATION             OF TAX
5.   AMOUNT OF CITY  SALES TAX                        3.46 % OF   LINE 4                                                              (5.  TOTAL 
6.   ADD: EXCESS TAX  COLLECTED                                                                                                       (6. 
7.   ADJUSTED CITY TAX:    (ADD LINES 5 & 6)                                                                                          (7. 
8.   DEDUCT   3.0%    OF LINE 7 (VENDORS FEE, IF PAID BY DUE DATE)                                      TO $100.00                    (8. 
9.   TOTAL TAX  (ITEM 7 MINUS 8)                                                                    TOTAL                             (9. 
10.    CITY USE TAX - SEE SCHEDULE   B             AMOUNT 
            ON REVERSE     SIDE                 SUBJECT    TO TAX                         ____________________________X  3.46%        =
11.  TOTAL TAX DUE:  (ADD  LINES 9 AND 10)                                                                     TOTAL                  (11. 
12.    LATE FILING - IF RETURN IS FILED      A. PENALTY 10%     X LINE 11                                                         (12A. 
           AFTER DUE DATE THEN       ADD-    B. INTEREST    1% FOR EACH MONTH      DELINQUENT X LINE 11                           (12B. 
13.  TOTAL TAX, PENALTY, AND INTEREST   DUE:  (ADD LINES 11, 12A & 12B)                                                               (13.  TOTAL 
14.                                                                                                                                   (14. 
15.  TOTAL DUE AND   PAYABLE                 (MAKE CHECK OR MONEY ORDER PAYABLECITY OFTOARVADA                         )              (15.  TOTAL 

                                                SCHEDULE B - IS LOCATED ON       THE BACK OF THIS FORM

THIS RETURN     FOR:                                                                                SPECIAL MESSAGE TO AND            FROM CITY/TAXPAYER

THIS RETURN     MAILED TO:



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                                                                                        SCHEDULE B -     CITY USE TAX
Arvada Use Tax applies to the storage, use, distribution, or consumption of tangible personal                property purchased, leased, or rented, unless specifically exempted, when a local tax
                                                        (City Portion) equal to or greater than Arvada’s     tax has not been paid on that property.
DATE OF PURCHASE                              NAME OF VENDOR                                                       TYPE OF COMMODITY PURCHASED                          PURCHASE  PRICE
                                                           (A) LIST OF PURCHASES (IF ADDITIONAL SPACE IS NEEDED  - ATTACH SCHEDULE IN SAME FORMAT) 

   (B) TOTAL PURCHASE PRICE OF PROPERTY    SUBJECT TO CITY USE TAX                                                                                                $ 
                                                                                ENTER TOTAL LINE (B) ON LINE 10 ON FRONT OF RETURN

 This return is used for both sales and use tax. You                                                            may owe tax even if you have no retail sales.
                                                                 Please fill out this return completely.
   NEW BUSINESS DATE                                                                                         SHOW BELOW CHANGE OF OWNERSHIP, NAME AND/OR ADDRESS, ETC.
   MO.   DAY    YR.            1. If ownership has changed, give date of change and new owners name.
                               2. If business has been permanently discontinued, give date discontinued.
                               3. If business location has changed, give new address.
   DISCONTINUED DATE        4. Records are kept at what address?__________________________________ 
   MO.   DAY    YR.         { 5. If business is temporarily closed, give dates closed.
                                                                                                                             '  BUS ADDRESS                ' MAILING ADDRESS 
PREPARATION OF              THIS RETURN
LINES 1-2B SALES            ACTIVITY:
1)     Total receipts from Arvada business activity must be reported and accounted                                       for in every return. This must include all sales, including
       rentals, leases, and service sales both taxable and non-taxable.
2)     Any merchandise on which the City tax has not been paid, and which has been personally consumed or used in the rendering of service,                                                       must
       be reported on Schedule             B Line 10 of this return.
3)     Collection of bad debts, previously deducted, must                             be accounted for in the month of collection.
4)     Total of Lines 1 and 2A are entered as total adjusted gross sales and service on Line 2B.
LINE 3 (A THROUGHSalesJ) DEDUCTIONS:of non-taxable merchandise and service included                                on Line 1 through 2B should be deducted
on Lines 3(A) thru 3(J). Deductions on Line 3(J) (Other Deductions) should be explained on Schedule A or an attached sheet.                                                  For additional
information consult your Arvada            Sales and Use Tax Ordinance.
LINEIf6:the total tax collections exceed the amount entered                             on Line 5A, report the excess tax collected on Line 6.
LINE 10 USEEnterTAX:the total purchases from Schedule B subject to use tax,                              See Section 31-51 of Arvada City Code for further explanation.
LINE 12 LATE FILING PENALTIES:Reports together with tax remittance, are due on or before the 20thday                                                of the month following        the period
under the report. Failure to file or pay the tax subjects the taxpayer to a penalty of 10% of the tax and interest of 1% per month from the date
tax was due. Cost of collection activities may occur because of late filing or non-payment of tax returns.
RECORDS:Records of both purchases and sales, including invoices, must be retained for a period of at least three years. The burden of proof 
of exempt sales and purchases rests with the taxpayer. Records                                 must be open for inspection by authorized City representatives.
SALES OR PURCHASE OF BUSINESS: Purchasers of businesses are liable for any unpaid taxes of predecessors. Vendors having out-
standing accounts on which Sales tax has not been remitted must compute                                         and pay the tax at the time of sale. Upon the sale of a business,
Sales/Use tax must be paid on the sale or purchase of fixtures, equipment,                                      machinery or other tangible personal property not a part of the stock
in trade of the  business.
OBLIGATION TO REPORT:All licensed taxpayers must complete, sign, and file their Sales                                               and Use tax returns even in cases when no taxes
are due. 

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

 ____________________________                              _________________________                         _____________________________                   _____________________ 
                 Signature                                          Name (Please           Print)                            Company                                    Date 

 ____________________________ 
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