CITY OF ARVADA                                                                             CITY OF ARVADA
                                                                                                                                            Tax & Audit Division
    SCHEDULE - A                              SALES & USE TAX RETURN                                                                        8101 Ralston Road
                                                                                                                                            Arvada, Colorado 80002
PERIOD                          DUE                     ACCOUNT                                                                             720-898-7100
COVERED                         DATE                    NUMBER
1.  GROSS SALES AND SERVICE      (TOTAL RECEIPTS FROM CITY ACTIVITY MUST BE REPORTED AND ACCOUNTED FOR IN EVERY RETURN INCL. ALL SALES,
                                 RENTALS, AND LEASES AND ALL SERVICES BOTH TAXABLE AND NON-TAXABLE)
2A. ADD: BAD DEBTS COLLECTED
2B. TOTAL LINES 1 & 2A                                                                                                                 TOTAL
3.  A  NON-TAXABLE SERVICE SALES              (INCLUDED IN ITEM 1)                                                                     A
    B  SALES TO OTHER LICENSED DEALERS FOR PURPOSES OF TAXABLE RESALE                                                                  B
D   C  SALES SHIPPED OUT OF CITY AND/OR STATE (INCLUDED IN ITEM 1)                                                                     C
E   D  BAD DEBTS CHARGED OFF             (ON WHICH CITY SALES TAX HAS BEEN PAID)                                                       D
D
    E  TRADE INS FOR RESALE                                                                                                            E
U
C   F  SALES OF GASOLINE AND CIGARETTES                                                                                                F
T   G  SALES TO GOVERNMENTAL, RELIGIOUS AND CHARITABLE ORGANIZATIONS                                                                   G
I   H  RETURNED GOODS                                                                                                                  H
O   I  PRESCRIPTION DRUGS/PROSTHETIC DEVICES                                                                                           I
N   J  OTHER DEDUCTIONS (ATTACH EXPLANATION)                                                                                           J
S
3.  TOTAL DEDUCTIONS                                                 (Total of Lines 3A thru 3J)                                       TOTAL
4.  TOTAL CITY NET TAXABLE SALES & SERVICE                           (Line 2B MINUS TOTAL LINE 3)
                                                        COMPUTATION OF TAX
5.  AMOUNT OF CITY SALES TAX                  3.46 % OF LINE 4                                                  (5. TOTAL
6.  ADD: EXCESS TAX COLLECTED                                                                                   (6.
7.  ADJUSTED CITY TAX: (ADD LINES 5 & 6)                                                                        (7.
8.  DEDUCT 3.0% OF LINE 7 (VENDORS FEE, IF PAID BY DUE DATE)                                       TO $100.00   (8.
9.  TOTAL TAX  (ITEM 7 MINUS 8)                                                              TOTAL              (9.
10.    CITY USE TAX - SEE SCHEDULE B       AMOUNT
           ON REVERSE SIDE               SUBJECT TO TAX               ____________________________X  3.46% =
11. TOTAL TAX DUE:  (ADD LINES 9 AND 10)                                                           TOTAL        (11.
12.    LATE FILING - IF RETURN IS FILED  A. PENALTY 10% X LINE 11                                               (12A.
        AFTER DUE DATE THEN     ADD-     B. INTEREST    1% FOR EACH MONTH DELINQUENT X LINE 11                  (12B.
13. TOTAL TAX, PENALTY, AND INTEREST DUE:  (ADD LINES 11, 12A & 12B)                                            (13.                   TOTAL
14.                                                                                                             (14.
15. TOTAL DUE AND PAYABLE                CITY OF ARVADA(MAKE CHECK OR MONEY ORDER PAYABLE TO                  ) (15.                   TOTAL

                                         SCHEDULE B - IS LOCATED ON THE BACK OF THIS FORM

THIS RETURN FOR:                                                                             SPECIAL MESSAGE TO AND FROM CITY/TAXPAYER

THIS RETURN MAILED TO:

                                                                               SCHEDULE B - CITY USE TAX
Arvada Use Tax applies to the storage, use, distribution, or consumption of tangible personal property purchased, leased, or rented, unless specifically exempted, when a local tax
                            (City Portion) equal to or greater than Arvada’s tax has not been paid on that property.
DATE OF PURCHASE          NAME OF VENDOR                                                          TYPE OF COMMODITY PURCHASED                              PURCHASE PRICE
                              (A) LIST OF PURCHASES (IF ADDITIONAL SPACE IS NEEDED  - ATTACH SCHEDULE IN SAME FORMAT) 

(B) TOTAL PURCHASE PRICE OF PROPERTY SUBJECT TO CITY USE TAX                                                                      $
                                                             ENTER TOTAL LINE (B) ON LINE 10 ON FRONT OF RETURN

This return is used for both sales and use tax. You may owe tax even if you have no retail sales.
                                 Please fill out this return completely.
NEW BUSINESS DATE                                                                                 SHOW BELOW CHANGE OF OWNERSHIP, NAME AND/OR ADDRESS, ETC.
MO.  DAY YR.             1. If ownership has changed, give date of change and new owners name.
                         2. If business has been permanently discontinued, give date discontinued.
                         3. If business location has changed, give new address.
   DISCONTINUED DATE 4. Records are kept at what address?__________________________________
MO.  DAY YR.         { 5. If business is temporarily closed, give dates closed.
                                                                                                        ' BUS ADDRESS           ' MAILING ADDRESS
PREPARATION OF THIS RETURN
LINES 1-2B SALES ACTIVITY:
1) Total receipts from Arvada business activity must be reported and accounted for in every return. This must include all sales, including
   rentals, leases, and service sales both taxable and non-taxable.
2) Any merchandise on which the City tax has not been paid, and which has been personally consumed or used in the rendering of service, must
   be reported on Schedule B Line 10 of this return.
3) Collection of bad debts, previously deducted, must be accounted for in the month of collection.
4) Total of Lines 1 and 2A are entered as total adjusted gross sales and service on Line 2B.
LINE 3 (A THROUGH J) DEDUCTIONS: Sales of non-taxable merchandise and service included on Line 1 through 2B should be deducted
on Lines 3(A) thru 3(J). Deductions on Line 3(J) (Other Deductions) should be explained on Schedule A or an attached sheet. For additional
information consult your Arvada Sales and Use Tax Ordinance.
LINE 6: If the total tax collections exceed the amount entered on Line 5A, report the excess tax collected on Line 6.
LINE 10 USE TAX:     Enter the total purchases from Schedule B subject to use tax, See Section 31-51 of Arvada City Code for further explanation.
LINE 12 LATE FILING PENALTIES:Reports together with tax remittance, are due on or before the 20thday of the month following the period
under the report. Failure to file or pay the tax subjects the taxpayer to a penalty of 10% of the tax and interest of 1% per month from the date
tax was due. Cost of collection activities may occur because of late filing or non-payment of tax returns.
RECORDS: Records of both purchases and sales, including invoices, must be retained for a period of at least three years. The burden of proof
of exempt sales and purchases rests with the taxpayer. Records must be open for inspection by authorized City representatives.
SALES OR PURCHASE OF BUSINESS:   Purchasers of businesses are liable for any unpaid taxes of predecessors. Vendors having out-
standing accounts on which Sales tax has not been remitted must compute and pay the tax at the time of sale. Upon the sale of a business,
Sales/Use tax must be paid on the sale or purchase of fixtures, equipment, machinery or other tangible personal property not a part of the stock
in trade of the business.
OBLIGATION TO REPORT: All licensed taxpayers must complete, sign, and file their Sales and Use tax returns even in cases when no taxes
are due.

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

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