(CHECKFiling frequency if applicable) ___ Monthly     ___Quarterly
                            TAXPAYER'S NAME AND ADDRESS                                                                                                        Annual
   PERIOD                                     ACCOUNT
   DUECOVERED                                 NUMBER                                                                 Town of Gypsum
   DATE                                                                                                              SALES TAX RETURN
                                                                                                                                     PO Box 130
                                                                                                                                     Gypsum, Co 81637
Company Name                                                                                                                         970-524-1753
Mailing Address                                                                                                      COMPUTATION OF TAX
City State Zip                                                                     5A. AMOUNT OF TOWN SALES TAX:  3% of LINE 4.                                      $ 0.00

                                                                                   6. ADD EXCESS TAX COLLECTED                                                       $ 0.00
                    (TOTAL RECEIPTS FROM TOWN ACTIVITY MUST BE                     7. ADJUSTED TOWN TAX: (ADD LINES 5A AND           LINE 6)                         $ 0.00
    GROSS SALES     REPORTED AND ACCOUNTED FOR IN EVERY RETURN INC.
1.  AND SERVICE     ALL SALES, RENTALS, AND LEASES AND ALL SERVICES       $ 0.00   8.                                                                                $ 0.00
                    BOTH TAXABLE AND NON-TAXABLE.)                                     Less Service Fee Rate  .0333 (If paid before due date)
2A. ADD - BAD DEBTS COLLECTED                                               $ 0.00 9.  Less Service Fee                                                              $ 0.00
2B. TOTAL LINES 1 & 2A                                                    $ 0.00   10.
    A. NON-TAXABLE          (INCLUDED IN                                                     (LATE FILING            A. PENALTY 10%
3.     SERVICE SALES        ITEM 1 ABOVE)                                          11. IF RETURN IS FILED    ADD
       FOR PURPOSES OF TAXABLE RESALE                                                                                MONTH
    B. SALES TO OTHER LICENSED DEALERS                 $ 0.00                          AFTER DUE DATE THEN)          B. INTEREST PER 1.34%                           $ 0.00
       TOWN AND/OR STATE    ITEM 1 ABOVE)
D   C. SALES SHIPPED OUT OF (INCLUDED IN               $ 0.00                      12. TOTAL TAX PENALTY DUE (ADD LINES 11A AND 11B)                                 $ 0.00
E   D. BAD DEBTS      (ON WHICH TOWN SALES             $ 0.00                          ADJUSTMENT PRIOR PERIODS      A. - ADD                                        $ 0.00
D      CHARGED OFF       TAX HAS BEEN PAID)                                        13. ATTACH COPY OF OVER OR
U   E. TRADE-INS FOR TAXABLE RESALE                    $ 0.00                          UNDERPAYMENT NOTICE -         B - DEDUCT                                      $ 0.00
C   F. SALES OF GASOLINE AND CIGARETTES                                                                                              (MAKE CHECK OR MONEY ORDER
T                                                      $ 0.00                      14. TOTAL TAX DUE AND PAYABLE
                                                                                                                                                                     $ 0.00
I   G. SALES TO GOVERNMENTAL, RELIGIOUS                $ 0.00                                                                        PAYABLE TO TOWN OF GYPSUM)
O      AND CHARITABLE ORGANIZATIONS
N   H. RETURNED GOODS                                  $ 0.00
S   I. PRESCRIPTION DRUGS / PROSTHETIC                 $ 0.00                      SCHEDULE - A - SPECIAL MESSAGE FROM TAXPAYER TO TOWN
                            DEVICES
    J. OTHER DEDUCTIONS (LIST)                         $ 0.00
    K.                                                 $ 0.00
    L.                                                 $ 0.00
       3.  TOTAL DEDUCTIONS            (TOTAL OF LINES 3 A THRU L)          $ 0.00
       SALES & SERVICE
4A. NET TAXABLE             (LINE 2B MINUS TOTAL LINE 3)                    $ 0.00

SCHEDULE - C - CONSOLIDATED ACCOUNTS REPORT
This schedule is required in all cases in which the taxpayer makes a consolidated return which includes sales made at more than one location.   It must be completely filled out and convey 
all information required in accordance with the column headings.  I
           ACCOUNT                                                  BUSINESS ADDRESSES                                               PERIODS TOTAL GROSS       PERIODS NET TAXABLE
             NUMBER                                                 OF CONSOLIDATED ACCOUNTS                                         SALES (AGGREGATE TO       SALES (AGGREGATE TO
                                                                                                                                     LINE 1 ABOVE)             LINE 4A ABOVE)
                                                                                                                                                     00              0.00
                                                                                                                                                     0.00            0.00
                                                                                                                                                     0.00            0.00
                                                                                                                                                     0.00            0.00
                                                                                                                                                     0.00            0.00
                                                                                                                                                     0.00            0.00
                                                                                                                                                     0.00            0.00
                                                                                                                                                     0.00            0.00
                                                                                                                                                     0.00            0.00
                                                                                      ENTER TOTALS HERE AND ABOVE                                    $ 0.00          $ 0.00
   NEW BUSINESS DATE                     DISCONTINUED DATE                             SHOW BELOW CHANGE OF OWNERSHIP NAME, AND/OR ADDRESS, ETC.
    MM       DD          YY              MM        DD          YY

1. If ownership has changed, give date of change and new owner's name.
2. If business has been permanently discontinued, give date discontinued.
3. If business location has changed, give new address.
4. Records are kept at what address?
                                                                                                                     BUS. ADDRESS                    MAILING ADDRESS
5. If business is temporarily closed, give date to be closed.
   I hereby certify under penalty of perjury that the statements made herein are to the best of my knowledge, true and correct.
    BY
                                                                    SIGNATURE                                                        DATE

                                                                    TITLE                                                                            PHONE

                                                                    COMPANY                                                                    EMAIL ADDRESS
REV. 1/2006