MAIL THIS RETURN WITH REMITTANCE TO: 

                                                                             CITY OF MADISON 
                                                                             P.O. BOX 99 
                                                                             MADISON, ALABAMA 35758 
                                 CITY OF MADISON, ALABAMA 
                                   RENTAL TAX- MONTHLY TAX REPORT 

Account Number: ________                                                       REPORTING PERIOD: ___/____ 

(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 

RENTAL TAX: 

AUTOMOTIVE RATE                                                                      1% 

GENERAL RATE                                                                         3% 

                             NOTE: DISCOUNT DOES NOT APPLY TO RENTAL TAX 

This return must be postmarked by 
       th
the 20  day of the month following 
the reporting period for which you are 
filing to be considered a timely return. 
                                                         (1) TOTAL TAX DUE
By signing this report I am certifying that              (Total of Column E)
this  report, including any accompanying                 (2) PENALTY
schedules or statements, has been                        (Item 1 x 10%)
examined by me and is to the best of my 
                                                         (3) INTEREST
knowledge and belief, a true and complete                (Item 1 x 0.5% per month
    report for the period stated.                        delinquent)
                                                         (4) NET TAX DUE
Date ________________________                            (Item 1 - Item 3; if
                                                         delinquent, items 1 + 2 + 3)
Title _________________________ 
                                                         TOTAL AMOUNT DUE & 
Signature _____________________                          ENCLOSED 

                                                   SUBMIT