SALES TAX DIVISION
             PO BOX 0845 - LOVELAND, CO 80539-0845                                         CITY OF LOVELAND
             (970) 962-2708 FAX (970) 962-2927                                             SALES TAX RETURN
             EMAIL: salestax@cityofloveland.org
             www.lovelandgovernment.org/salestax

             TAXPAYER NAME & ADDRESS                                                  PERIOD          DUE DATE          CITY LICENSE #

             ONLINE FILING IS AVAILABLE AT                                       A ZERO RETURN MUST BE FILED IF NO TAX IS DUE
   www.cityofloveland.org/services/finance/sales-tax/online-portal-citizen-access
1.  GROSS SALES AND SERVICE:                                                     5.  Amount of City Sales Tax:
    (TOTAL RECEIPTS, BEFORE SALES TAX,                                               3.0% of Line 4
    FROM CITY ACTIVITY MUST BE REPORTED                                          6.  ADD: Excess Tax Collected:
    INCLUDING ALL SALES, RENTALS, LEASES, &                                      7.  Total City Sales Tax:
    SERVICES, BOTH TAXABLE & NON-TAXABLE)                                            (Add lines 5 and 6)
2A. ADD: BAD DEBTS COLLECTED                                                     8A:                  Penalty: 10% 
                                                                                                      of line 7 or $15, 
2B: TOTAL OF LINES 1 & 2A                                                             Late Filing: If whichever is 
3.  A. Non-Taxable Service or Labor:                                                  Return is Filed   greater
    B. Sales To Other Licensed Dealers                                                After Due Date 
    for Purposes of Taxable Resale                                               8B:    Then Add:     Interest: 1% 
                                                                                                      per Month of 
D   C. Sales Shipped Out of City:                                                                       line 7
E   D. Bad Debts Charged Off:                                                    9A. Amount Subject to Tax
D   (on which tax was previously paid)                                               from Schedule B:
U   E. Trade-in For Taxable Resale:                                              9B. 3.0% of line 9A
C   F. Sales of Gasoline and Cigarettes:                                         10. Total Tax Due & Payable:
T   G. Sales to Governmental, Religious,                                             (add lines 7, 8A, 8B, 9B)
I   and Charitable Organizations:                                                11. Adjustments Prior Periods:
O   H. Returned Goods:                                                               (attach copy of notice)
N   (on which tax was previously paid)                                              TOTAL DUE & PAYABLE:
S   I. Prescription Drugs & Prosthetic                                                     Payable to:
    Devices:                                                                            City of Loveland
    J. Food Stamps:
    K. Lodging Over 30 Days:                                                                          SCHEDULE B
    L. Other (Please Explain):                                                                                           Purchase Price
TOTAL DEDUCTIONS (Total of Lines 3A - 3L)                                        Building Materials Subject to Use Tax: $
4.  TOTAL NET TAXABLE SALES & SVCS:                                              Sale/Purchase of Business Equipment:   $
    (line 2B minus total deductions)
                                                                                           Total Price Subject to Tax   $
   SHOW BELOW ANY CHANGE OF BUSINESS NAME, OWNERSHIP, OR ADDRESS                           (Enter Total on Line 9A)

                                                                                    I, hereby certify, under penalty of perjury, that the statements made 
                                                                                       herein are to the best of my knowledge true and correct.
                                                                                 Name:
                                                                                 Signature:
    BUS. ADDRESS                    MAILING ADDRESS                              Phone:
DATE OF BUSINESS CLOSURE OR SALE:                                                E-Mail:
                                                                                 Date:

                                                                                                            Revised November 2019   Page 1