MAIL THIS RETURN WITH REMITTANCE TO: 

                                                                             CITY OF MADISON 
                                                                             P.O. BOX 99 
                                                                             MADISON, ALABAMA 35758 
                               CITY OF MADISON, ALABAMA 
                               SALES AND USE TAX- MONTHLY TAX REPORT 

Account Number: ________                      REPORTING PERIOD: From___/___/____ To ___/___/____ 

(This return is only for the business shown below) 

Business Name: _____________________________________________________ 

Business Address: ____________________________________________________ 

        Check here if this is a final tax return 

                            GROSS 
TYPE OF TAX/TAX             TAXABLE              TOTAL                                   GROSS TAX 
     AREA                   AMOUNT          DEDUCTIONS       NET TAXABLE     TAX RATE        DUE 
SALES TAX: 
GENERAL RATE                                                                 3.50% 
AUTOMOTIVE RATE                                                              1.75% 
MACHINERY RATE                                                               1.75% 
USE TAX: 
GENERAL RATE                                                                 3.50% 
AUTOMOTIVE RATE                                                              1.75% 
MACHINERY RATE                                                               1.75% 
     DISCOUNT IF PAID ON TIME: 5% ON $100 OR LESS IN TAX; PLUS, 2% ON TAX OF $100, IF ANY 

 This return must be postmarked by 
         th
the 20  day of the month following                     (1) TOTAL TAX DUE
                                                       (Total of Column E)
the reporting period for which you are 
  filing to be considered a timely return.             (2) PENALTY
                                                       (Item 1 x 10%)
By signing this report I am certifying that 
                                                       (3) INTEREST
this report, including any accompanying 
                                                       (Item 1 x 0.5% per
 schedules or statements, has been 
                                                       month delinquent)
examined   by me and is to the best of my 
knowledge and belief, a true and complete              (4) DISCOUNT
   report for the period stated.                       (if submitted prior to
                                                       due date)

                                                       (5) NET TAX DUE
Date ________________________                          (Item 1 - Item 4; if
                                                       delinquent, items 1 +
Title _________________________ 
                                                       2 + 3)
Signature _____________________                        TOTAL AMOUNT DUE 
                                                       & ENCLOSED 

                                                   SUBMIT