CITY OF LITTLETON CO 
                                               CONSUMER USE TAX RETURN 
                                               2255 W. Berry Ave. Littleton, CO 80120 
                                               (303)795-3768 

                                USE TAX IS DUE IF: You purchased items without paying sales tax or the total sales tax rate paid was less than 7.25%  
                                         and your items purchased were stored, used, or consumed in Littleton. 

                      PURCHASER: 
                      ADDRESS: 
                      City, State, Zip                                                                                      Payment Due Date: 

                                               Section "A" - Use Tax Due 

Some sellers do not collect local (City of Littleton) sales tax. A purchase is not exempt                 A                 B                         C 
from sales tax because it is made over the Internet, bought from a mail order catalog, 
or the seller did not collect sales tax. You are required to pay Littleton Use Tax on all                 Purchase Price of Use Tax           Use Tax Due 
purchases on which the total tax rate charged was less than 7.25% and the property                        Tangible Property Rate 
is stored, used, or consumed in Littleton. Only Littleton use tax is paid to the City. 
                                                                                                        $                   3% 
Items exempt from taxation in Littleton are: Food for home consumption; prescription                                                  $ 
drugs, prescription eyeglasses and contact lenses; Automotive vehicles licensed 
outside the City; Gasoline; Cigarettes; Newspapers. A complete list of exempt property                                                             ( C = A x B ) 
can be obtained from the Sales Tax Department. 

                                               Section "B" - List of Property Purchased 
                                                                                                      A     B               C             D                      E
                                                                                                          Use Tax           Local       Local 
                      Vendor/Lessor Name Description of Items Purchased Purchase Price                     Rate             Sales Tax Sales Tax         Use Tax Due 
                                                                                                                            Due         Paid 
                    1                                                                  $                    3%                                      $ 
                    2                                                                                       3% 
                    3                                                                                       3% 
                    4                                                                                       3% 
                    5                                                                                       3% 
                    6                                                                                       3% 
                    7                                                                                       3% 
                    8                                                                                       3% 
                    9                                                                                       3% 
                                        (Attach additional sheet(s), using same format, if necessary)                       (A x B)   (Per Invoice)     (C-D) 

                                                                                                                Total Tax Due                       $ 

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