Account #                                                                                                          MAIL THIS RETURN WITH REMITTANCE TO: 
                                                                                                                                                 
Reporting Period                                                                                                            City Clerk - Revenue Dept 
Business Name                                                                                                               1040 Park Drive 
                                                                                                                            Leeds, AL 35094 
                                                                                                                                                 
Total Amount Remitted                                                                                                       (205)-699-2585 
                                                                                                                            (205)-699-6558 Fax

             Type of Tax       [A]                                           [B]       [C]                             Tax  Gross Tax Due [E] 
                               Gross Taxable Amount           Total Deductions         Net Taxable [A-B]               Rate [Net Taxable x Rate]
Sales:

     General                                                                                                           4%
     Manufacturing Machinery                                                                                           1%
     Automobile                                                                                                        1%

     Farm Machinery                                                                                                    1%
     Vending                                                                                                           4%
Seller's Use:

     General                                                                                                           4%
     Manufacturing Machinery                                                                                           1%
     Automobile                                                                                                        1%
     Farm Machinery                                                                                                    1%
Consumer Use:

      General                                                                                                          4%
      Manufacturing Machinery                                                                                          1%
     Automobile                                                                                                        1%
     Farm Machinery                                                                                                    1%
Rental/Lease:

     General                                                                                                           3%
     Automobile                                                                                                        4%
     Linens                                                                                                            3%
     All Other                                                                                                         3%
Lodging Tax:                                                                                                           6%
                                                                                       (1) Total Tax (Total of Col [E])
This return must be received or postmarked by the 20th day of the month following the  
reporting period for which you are filing to be considered a timely return.            (2) Penalty - 10%
                                                                                       (3) Interest - 1% per month
  
By signing this report, I am certifying that this report, including any accompanying   (5) NET TAX DUE
schedules or statements, has been examined by me and is to the best of my knowledge    (6) Less Credits -  
and belief, a true and complete report for the period stated.                          MUST attach documentation
                                                                                       (7) TOTAL AMOUNT DUE

                    Signature                                                          Date
                    Print Name                                                         Title

                                   Standard Deduction Summary Table 
            (SUMMARY BELOW MUST BE COMPLETED TO CORRESPOND WITH TOTAL DEDUCTIONS ON FRONT OF TAX REPORT)

Type of Tax Wholesale    Auto            Labor/Non- Sales Delivery Sales to Gov't           Sales of Gas          Other Allowable   Total 
                   Sales Trade-ins Taxable Service  Outside Juris. or its Agencies           or Lube Oils         Deductions*       Deduction

Total  
Deduction
Other Allowable Deductions (Explanation):

                         INSTRUCTIONS & INFORMATION CONCERNING THE COMPLETETION OF THIS REPORT 
                                                      
*  To avoid the application of penalty and/or interest amounts, this report must be filed on or before the 20th of the month  
    following the period for which the report is submitted. Cancellation postmark will determine timely filing. 
*  A remittance for the total amount due made payable to the tax jurisdiction must be submitted with this report. 
*  This report should be submitted on a monthly basis unless you have requested and been approved for a different filing frequency. 
*  Any credit for prior overpayment must be approved in advance by the taxing jurisdiction. 
*  No duplicate or replicate forms acceptable except with prior approval of the taxing jurisdiction.

                                         Indicate any Account Changes Below

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