TAXPAYER'S NAME & ADDRESS
                                                                                                                                 CITY OF EVANS SALES AND USE TAX RETURN

                                                                                                                    Mail To: Sales Tax Division                          Email:   salestax@evanscolorado.gov
                                                                                                                                     PO Box 912324                       Phone: (970) 475-1109
             YOU MUST FILE THIS RETURN EVEN IF LINE 14 IS ZERO                                                                       Denver, CO 80291-2324               Fax:     (970) 475-1194

    PERIOD COVERED                         DUE DATE                                        ACCOUNT #

                                                                                 COMPUTATION OF SALES TAX
                                                                                                                    5A. FOOD FOR HOME CONSUMPTION SALES TAX
    GROSS SALES AND SERVICES: (BEFORE SALES TAX)                                                                                                                                                            $
                                                                                                                                                                  X 4.5%
1.  MUST BE REPORTED INCLUDING ALL SALES, RENTALS,                               $                                  5C . SALES TAX FOR ANY ITEMS NOT INCLUDED IN 5A (ABOVE)                                 $
    LEASES, AND SERVICES, BOTH TAXABLE AND NON-TAXABLE                                                                                                            X 4.5%
2A. ADD:  BAD DEBTS COLLECTED WHICH WERE PREVIOUSLY DEDUCTED                     $                                  6.   ADD: EXCESS TAX COLLECTED                                                          $
2B.                                                ADD LINES 1 & 2A              $                                  7.   NET ADJUSTED SALES TAX (ADD LINES 5A, 5B AND 6)                                    $
    A. NON-TAXABLE SERVICES OR LABOR                                             $                                  8.   DEDUCT 3.33% OF LINE 7 (ENTER 0 IF RETURN IS FILED LATE)                           $
                                                                                                                                     **MAXIMUM AMOUNT ALLOWED IS $100**
3.  B. SALES TO OTHER LICENSED DEALERS FOR PURPOSE OF TAXABLE RESALE             $                                  9.   TOTAL SALES TAX DUE (LINE 7 MUNUS LINE 8)                                          $
    C. SALES SHIPPED OUT OF THE CITY OF EVANS                                    $                                       LATE FEES DUE IF  PENALTY: GREATERLINE 9 OF $15 OR 15% OF$                          PUT TOTAL BELOW
                                                                                                                    10.  FILED AFTER DUE   INTEREST: .75% FIRST MONTH 1.5% EACH
D   D. BAD DEBTS CHARGED OFF (ON WHICH CITY TAX WAS PREVIOUSLY PAID)             $                                               DATE                       ADD'L MONTH OF LINE 9 $                         $
E
D   E. TRADE-INS FOR TAXABLE RESALE                                              $                                  11.  PRIOR PERIOD ADJUSTMENT FOR OVER OR UNDERPAYMENTS                                  $
U   F. SALES OF GASOLINE AND CIGARETTES                                          $                                  12.  TOTAL DUE AND PAYABLE - ADD LINES 9 THROUGH 11                                     $
C
T   G. SALES TO GOVERNMENTAL, RELIGIONS AND CHARITABLE ORGANIZATIONS             $                                  13.  TOTAL USE TAX DUE - FROM USE TAX SCHEDULE BELOW                                    $
                                                                                                                         TOTAL TAX DUE AND PAYABLE - ADD LINES 12 AND 13
I   H. RETURNED GOODS (ON WHICH CITY TAX WAS PREVIOUSLY PAID)                    $                                  14.       (MAKE CHECK PAYABLE TO THE CITY OF EVANS)                                     $
O
N   I. PRESCRIPTION DRUGS / PROSTHETIC DEVICES                                   $                                       My signature affirms that I have read this return and it is true and correct to the best of my
S   J. FOOD PURCHASED W/ FOOD STAMPS/WIC VOUCHERS                                $                                       knowledge and is signed subject to penalties for perjury and other criminal offenses.
    K. OTHER DEDUCTIONS (PLEASE EXPLAIN)                                         $                                       SIGNATURE:
3.           TOTAL DEDUCTIONS (ADD LINES 3A THRU 3K)                             $                                       DATE:                                                    TITLE:
4.  TOTAL CITY NET TAXABLE SALES & SERVICE (LINE 2B MINUS LINE 3)                $                                       PHONE:                                                   E-Mail:

                                                                                 COMPUTATION OF USE TAX
                         The City of Evans imposes a  .5%4tax upon the privilege of using, storing, distributing or consuming in the City tangible property or taxable services purchased, rented or leased.
  Date of Purchase                Name of Vendor                                                                    Address                                                                          Amount
                                                                                                                                                                                           $
                                                                                                                                                                                           $
                                                                                                                                                                                           $
                                                                                    Multiply Subtotal by 4.5%                                      Total Use Tax Payable:                  $
                                                                       CONSOLIDATED ACCOUNTS REPORT
                            This scheduled is required in all cases where the vendor is reporting sales for more than one location within the City of Evans.  Each location must have a separate license.
  Account Number                     Business Location Address                                      Total Gross Sales                              Total Deductions                                  Net Taxable Sales
                                                                                           $                                              $                                                $
                                                                                           $                                              $                                                $
                                                                                    Totals $                                              $                                                $
                                                          For any changes, Please send e-mail to salestax@evanscolorado.gov

                                                                                                     SALES TAX RETURN INSTRUCTIONS

Line 3C If you deliver or ship product out of the City of Evans and you are unsure of the "in/out"    Line 10   Returns are due on the 20th day of the month following the reporting period.  For      
        status of the address, please email or call our division for verfication. An address locator            example on a MONTHLY return:  The due date for the period of May 1st through May  
        is available on our website and by request from our division.                                           31st is June 20th.  For example on a QUARTERLY return:  The due date for the period
                                                                                                                of April 1st through June 30th is July 20th.  Returns are considered late if the payment   
                                                                                                                or return is not received, or if the envelope is not postmarked by the USPS, on or before
                                                                                                                the due date.
Line 3G Sales to exempt organizations must be supported by a "State of Colorado" exemption
        certificate.  Place the exempt number of the organization on your invoice.  The number                  Penalty           Late returns will be assessed a penalty equal to the sum of $15, or
        must begin with "98" (i.e., 98-xxxxx-xxxx).                                                             Calculation:      fifteen percent (15%), whichever is greater.
                                                                                                                                  Tax Due                    Penalty
                                                                                                                                  $0.00 through $100.00      $0.00 through $100.00
Line 3K Only food purchased with food stamps, or WIC vouchers may be deducted.  The City of                                       $100.01 and up             $100.01 and up
        Evans tax rate on "Food for Home Consumption" is 4.5%.  Do not deduct food sold 
        unless stamples or vouchers are collected from the customer.                                            Interest          Late returns are assessed interest equal to .75% of balance owed  
                                                                                                                Calculation:      and will be applied from the due date of the payment.  On remittance
                                                                                                                                  of Sales or Use taxes that are delinquent by more than thirty (30)  
                                                                                                                                  calendar days from the due date as set forth in Chapter 3.04.840 of
                                                                                                                                  the Municipal Code additional penalty interest of .75% are applied.
Line 5A The tax rate on "Food for Home Consumption" is 4.5%. Enter Food for Home 
        Consumption receipts and multiply this amount by 4.5%.            primarilyis This groceries                              For example, interest on a late return for the Period of May 1st
        and other foods that are not prepared prior to purchase or consumed on premises.                                          through May 31st is calculated as follows:
        Do not include food furnished by restaurants, alcholic beverages, food items not 
        marketed for human consumption (pet food), and all non-food items.                                      Tax Due      Number of Months Late Interest Due
                                                                                                                June 20th             0          None
                                                                                                                June 21st             1          Tax Due x .75% x 1
Line 5B                                                                                                         July 23rd             2          Tax Due x 1.5% x 2 (intereset + penalty interest)
        Enter receipts for any items not included in the Food for Home Consumption sales tax 
        (5A). Multiply this amount by 4.5%.                                                                     August 19th           2          Tax Due x 1.5% x 2 (intereset + penalty interest)
                                                                                                                August 21st           3          Tax Due x 1.5% x 3 (intereset + penalty interest)

Line 6                                                                                                Line 11   If you received a credit notice, please deduct the credit amount here.  If you receive a
        If sales taxes collected during the reporting period exceed the amount calculated on Line               notice of tax deficiency for underpaid tax, please add the total amount of the deficiency
        4, you must report and remit the excess on this line.                                                   due here.

                                                                                                      Sale of a If your business has been sold to a new owner, sales tax may be due on the selling        
Line 8  This amount reimburses the vendor for collecting our sales tax.  It is not an additional      Business  price of the tanglible personal property assets, except for inventory to be resold.     
        cost to the vendor.  Do not add this calculation to the tax.  The amount you keep is                    Report the taxable sales amount and tax due on a separate tax return noting that the
        limited to $100 per return.                                                                             return is for the sale of the business.  See City Code Section 3.04.610 for a list of    
                                                                                                                types of business sales that are subject to sales tax.