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(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