A RETURN IS REQUIRED 
                                                           CITY OF CENTENNIAL SALES TAX RETURN                                                                    EVEN IF NO TAX IS DUE

Taxpayer Name:
                                                                                                                        Filing Period:
Location Address:                                                                                                       Due Date: (20th of the month 
                                                                                                                        following the end of the reporting 
                                                                                                                        period)
City, State, Zip
                                                                                                                        Centennial License No:

             GROSS SALES AND SERVICE (Total receipts from City activity must be 
1.           reported and accounted for in every return including sales, rentals and               5.   AMOUNT OF CITY SALES TAX (Line 4 x 2.5%)
             leases and all services both taxable and non-taxable)                                 
             A. ADD: BAD DEBTS COLLECTED                                                           6. ADD: EXCESS TAX COLLECTED
2.
             B. TOTAL (Add Lines 1 and 2A)
                                                                                                   7.   TOTAL TAX DUE (Add Lines 5 and 6)
3.           A. NON-TAXABLE SERVICE SALES
             B. SALES TO OTHER LICENSED                                                                                 (a)  PENALTY = GREATER OF $15 OR 15% ON 
                DEALERS FOR RESALE                                                                        LATE FILING - TAX DUE (Line 7)
                                                                                                   8.     IF FILED AFTER
             C. SALES SHIPPED OUT OF CENTENNIAL                                                        DUE DATE ADD:    (b)  INTEREST = 1.5% PER MONTH ON TAX 
                                                                                                                        DUE (Line 7 x 1.5%)
             D. BAD DEBTS CHARGED OFF                                                              9.  TOTAL TAX, PENALTY, AND INTEREST DUE 
                                                                                                        (Add lines 7 and 8(a) and 8(b))
             E. TRADE-INS FOR TAXABLE RESALE                                                           A. ADD: (PRIOR PERIOD ADJUSTMENT)
                                                                                                   10.
             F. SALES OF GASOLINE AND CIGARETTES                                                       B. DEDUCT: (PRIOR PERIOD ADJUSTMENT)
             G. SALES TO GOV'T, RELIGIOUS, AND 
  DEDUCTIONS    CHARITABLE ORG.                                                                                         If this amount is $10 or less, you may record 
             H. RETURNED GOODS                                                                     11.    TOTAL DUE     the amount due and carry the amount forward 
                                                                                                        AND PAYABLE     for payment on a future return when the 
             I. PRESCRIPTION DRUGS /                                                                                    threshold of $10 has been reached.
                PROSTHETIC DEVICES
             J. FOOD                                                                                              MAKE CHECK OR MONEY ORDER PAYABLE TO:
             K. OTHER DEDUCTIONS (LIST)                                                                                      CITY OF CENTENNIAL
             L.                                                                                                   3% VENDOR ALLOWANCE - ONLINE FILED ONLY
                                                                                                                                       IF PAID BY DUE DATE
             M.  TOTAL DEDUCTIONS (Total of Lines 3A through 3L)                                                                       Maximum Allowance = $200.00
                                                                                                                                       Minimum Allowance = $3.00
4.           NET TAXABLE SALES & SERVICE (Subtract line 3M from 2B)

SCHEDULE A - SPECIAL MESSAGE TO / FROM THE CITY

                              SCHEDULE B                                                           SCHEDULE C-CONSOLIDATED ACCOUNTS
DO NOT COMPLETE THIS SECTION - NOT CURRENTLY IN USE BY THE              This schedule is required in all cases in which the taxpayer makes a consolidated return which includes sales made at more than one location.  
                              CITY OF CENTENNIAL                        It must be completely filled out and convey all information required   in accordance with the column headings.  If additional space is needed 
                                                                                     attach schedule in same format.  Attach a supporting schedule that details lines 1, 2, 3, and 4 on Schedule A for each location.
                                                                                     CENTENNIAL    BUSINESS LOCATION ADDRESS            PERIOD'S TOTAL GROSS                PERIOD'S NET
                                                                                     LICENSE NO                                               SALES                          TAXABLE SALES

                     NOT APPLICABLE

                                                                                                                                       LINE 1                         LINE 4
                                                                                     ENTER TOTAL HERE AND IN LINES 1 AND 4 ABOVE
                              NEW BUSINESS DATE:                                       CHANGE OF LOCATION ADDRESS                             CHANGE OF MAILING ADDRESS

             MONTH                        DAY                      YEAR Address 1:                                      Address 1:
                                                                        Address 2:                                      Address 2:
                              DISCONTINUED DATE:                        City/State/Zip:                                 City/State/Zip:
             MONTH                        DAY                      YEAR Phone:                                          Phone:
                                                                        Contact Person:                                 Contact Person:
I HEREBY CERTIFY UNDER PENALTY OF PERJURY, THAT THE STATEMENTS MADE HEREIN ARE, TO THE BEST OF MY KNOWLEDGE, TRUE AND CORRECT.
Signature:                                                                                                                             Date:
Printed Name:                                                           Title:                         Phone:                          Email:

                              PLEASE REMIT TO: CITY OF CENTENNIAL, REMITTANCE CENTER, P.O. BOX 17383, DENVER, CO 80217-0383
                                  FOR QUESTIONS, PLEASE VISIT OUR WEBSITE AT www.centennialco.gov  OR CALL 303.325.8000
                 Rev 1/24/2019