City of Palmer ● Department of Finance 
                              231 W. Evergreen Avenue ● Palmer, AK 99645 
                                 Phone: 907-745-3271 Fax: 907-745-0930 
                                                   www.palmerak.org 

                                       Sales Tax Remittance Form 

                        Please indicate the time frame you are filing this return for: 
                              Month Ending 
                        4     Quarter Ending 

                                                   Palmer Business License No. 

Business Name 
Mailing Address 
                        City                                          State                     Zip 

                Consumers Tax on Sales, Services, Etc. Palmer Municipal Code 3.16 
Your gross revenue must include the amount of all sales rentals & services, all nontaxable sales, rentals & 
services, including amounts over the $1,000 maximum tax cap. 
Gross revenue from retail sales                                                           $                             1. 
Gross revenue from sales & services rendered, inc. materials                              $                             2. 
Gross revenues from residential and commercial rentals                                    $                             3. 
Gross revenues from other sources                                                         $                             4. 

                                                                       Total revenues  $                                5. 
Less exceptions claimed per Palmer Municipal Code 
                                                                                          $
(attach statement itemizing exceptions)                                                                                 6. 
                                    Net taxable revenue – Line 5 minus Line 6  $                                        7. 
Computation of tax Line 8: 3% of line 7                                                   $                             8. 

Late Filing Fee  Line 9: $25.00                                                           $                             9. 
Penalty Line 10: In addition to the fee, a penalty of 5% of the tax for each month 
or portion thereof late after duedate, until total penalty of 20% has been accrued.       $                             10. 
Line 10 =Line 8 x 5% for eachmonth or portion thereof late (maximum 20%) 
Interest Line 11: 0.15 times tax amount divided by 365 times number of days         late        
                                                                                          $                             11. 
                                       Total Amount Due (add lines 8, 9, 10, 11 )  $                                    12. 

The sales tax return, and the related remittance of sales tax, is due and must be received, not merely 
postmarked, by the City not later than 5 pm on the last business day of the month immediately
following the month, quarter, or semi-annual period for which the return was prepared.  

I declare, subject to the penalties prescribed in Chapter 3.16.160 of the Palmer Municipal Code, that this return 
and any accompanying statements has been examined by me and to the best of my knowledge, this return is a
true, correct and complete return.  

   __________________________________________________________________________________ 
   Signature of firm member, owner or agent                                                     Date 

                                                   FOR OFFICE USE ONLY 
             Mail _____                                                              Received 
             Counter ______
             Drop Box _____
                                                                                                    Revised January 2023