City of Edgewater 
@       cityofd                                                              c/o Finance Department 
                                                                  1800 Harlan Street, Suite C                        Phone: 720-763-3003 
�e  gewater                                                                  Edgewater, CO 80214                Email: salestax@edgewaterco.com 
  --:I    Sales and Use Tax Return 
Name of Business:                                                 Company Name: (If different) 
Physical Address:                                                 Mailing Address:  (if different) 

City of Edgewater Account#: 
Report Period: Month                      Year                    Check here if this is 
                                                                  an amended return     □ 
1 Gross Sales & Service                                        6  City Sales Tax 3.5% of Line 5 
2A  Add: Bad Debts Collected                                   7  Excess Tax Collected 
2B  Total 1 + 2A                                               8  Adjusted City Tax (Add Lines 6 + 7) 
                                                                  Service Fee Allowed (2% of line 8 up to $200 max.) 
3 A.  Non-taxable Service                                      9  Must enter zero if return is late.                        0.02 
  B. Sales for Resale                                          10 TOTAL SALES TAX (line 8 minus line 9) 
  C. Shipped Out of City                                       11 Use Tax Due (Fill out completely schedule B below)        0.035 
  D.  Bad Debts                                                12A  TOTAL TAX DUE (Add Lines 10 & 11) 
  E.  Trade-Ins for Resale                                     12B  Penalty 10% of Total on line 12A if late                0.10 
  F.  Gas & Cigarettes                                         12C  Interest 1.0% per month x line 12A                      0.0125 
  G.    Government, Religious, Charitable                      13 TOTAL TAX, PENALTY & INTEREST (Add Lines 12A & 12B & 12C) 
  H. Returned Goods                                            14A  *Add 
  I.  Prescriptions                                            14B  *Deduct 
  J. Other Deductions
        (List on separate sheet)                                  *Please Use Line 14A or 148 only if you have received
                                                                  notification from the City to do so.
4 Total Deductions(add lines A - J ) 
5 Net Taxable (line 2B minus line 4)                           15            TOTAL DUE AND PAYABLE           >>>>>>>>>>>>>>>>>>>>> 

                                               SCHEDULE B -CITY USE TAX 
  The Edgewater Municipal Code (Sec. 4-3-320) imposes a tax on every person who uses, stores or consumes tangible 
                               personal property or services purchased inside or delivered into the City. 
Date of Purchase               Name of Vendor & Address                      Type of Commodity Purchased                    Purchase Price 

                                               Total purchase price of property/service subject to City use tax.»> 
Use second sheet If                                                                                                  »> 
  needed.                                      Use Tax Due:       Multiply total amount above X 3.5% and enter here.
IMPORTANT!                     YOU MUST  FILL  OUT  THE  INFORMATION  BELOW  &  SIGN YOUR  RETURN. 
        RETURN MUST BE RECEIVED or POSTMARKED BY THE 20TH OF THE MONTH FOLLOWING REPORTING PERIOD. 
                                                               I declare under penalties of perjury that the information contained on this form is true and correct to the best of 
Please check here D if changes to mailing or business address. my knowledge. 
                                                               Signature: ___________________  Date:  ______  _ 
Check if Applicable:  Business 
                                                               Print Name:  ______________  Title: _________  _ 
Closed  D  Date:. _____ _ 
                                                               Email: _____________  Phone: _____________  _ 

  Make check payable to:                                          Remit completed form and payment to: 
  City of Edgewater                            City of Edgewater• 1800 Harlan Street, Suite C • Edgewater, CO• 80214 
Edgewater Sales Tax Form
V1-2022