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: 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 

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