City and County of Denver 
                    Denver Occupational Privilege Tax Return                                  Department of Finance, Treasury Division 
                                                                                              P.O. Box 660859 
                                            Annual                                            Dallas, TX  75266-0859 

Business Name       Account Number          Phone Number 

                                                                         
                                                                           YOU MUST FILE A RETURN EVEN IF YOU 
Primary Business Location                   Period End Date                HAVE DETERMINED NO TAX IS DUE 

This special annual return, in lieu of your quarterly returns, is available to all   individuals, sole-proprietors and 
partnerships without employees liable for the tax. 

* If during the course of the year your liability changes (e.g. by adding an employee or an additional partner) it is
your responsibility to notify Denver Treasury and file an amended return.

All businesses located in Denver or performing work in Denver, regardless of the length or duration, are required 
to pay the minimum $4.00 Business Occupational Privilege Tax for each month even when there are no taxable 
employees. 

Line 1:  The Amount Due is the number of active self-employed individuals, owners, or partners of the business 
for each month of the year multiplied by $4.00. 
For example: One (1) self-employed taxpayer for each month = 1 x 12 x $4.00 = $48.00 

Line 2b:  If the return is filed or paid after the due date, enter 15% of line 1 or $25.00, whichever is greater. 

Line 2a:  If the return is filed or paid after the due date, enter 1% of line 1 for each month or part of a month past 
due. 

Line 3:  Add line 1, line 2a and line 2b.  Enter the total.  This is the total amount owed.  Include a check or money 
order made payable to Manager of Finance. 

                                                                                             
                                        RETURN LOWER PORTION - DETACH HERE

CHECK HERE IF THIS IS AN AMENDED RETURN     DENVER OCCUPATIONAL  PRIVILEGE TAX RETURN (ANNUAL) 
ACCOUNT  NUMBER TAX TYPE                    PERIOD  DUE DATE               AMOUNT  DUE              MEDIA #    
                Occupational  Privilege Tax                                                         000000000005 
NAME: 
                                            Line 1  AMOUNT DUE:                                   > 
PRIMARY BUSINESS LOCATION: 
                                            Line 2  Late Filing - if  a. Penalty: $25.00          > 
                                                    return is filed 
                                                    after due date -  b. Interest: 1% for each
                                                    Add:                 month the return is late > 

                                            Line 3  Total Due and Payable:                        > 

           000000000005                             Make checks payable to: Manager of Finance 
SIGNATURE                                   TITLE                                                   DATE 

                                                                           00000000000500000000005