Shelby County Business Revenue 
          Sales, Use, Rental, Lodgings, & Tobacco Tax Return  
                                                                                          Mail this return with remittance to: 
Reporting Period                                                                               Shelby County Business Revenue Office 
                                                                                                   200 West College Street, Room 115 
                                                                                                            Columbiana, AL 35051 
Shelby County Account #                                                               Phone: 205-670-6520 • Email: salestax@shelbyal.com 
Business Name & Address:                                                                                    Make check payable to: 
                                                                                                        Shelby County Business Revenue 

                                                                                          Enter Amount                    Enter Check # 

                                                                                      $ 
        Check here if your business is closed 
                                                          (A)           (B)               (C)                    (D)                   (E) 
          Type of Tax                           Gross Taxable           Total         Net Taxable Sales          Tax Rate         Gross Tax Due 
                                                      Sales         Deductions*       (Column A - Column B)                      (Column C x Column D) 

SALES (General )                                                                                                 .01 

SALES (Machine Rate/Vending)                                                                                    .00375 

SALES (Automotive)                                                                                              .00375 

SALES (Grocery Rate)                                                                                             .01 

USE-Sellers/Consumer (General)                                                                                   .01 

USE-Sellers/Consumer (Auto/Machine Rate)                                                                        .00375 

USE-Sellers/Consumer (Grocery Rate)                                                                              .01 
RENTAL (General) 
                                                                                                                 .03 
RENTAL (Automotive)                                                                                             .01125 
LODGINGS                                                                                                         .07 
TOBACCO 
(No. of Unstamped Tobacco Products Sold x 0.04)                                                                  .04 
By signing this report, I am certifying that this report, including 
any accompanying schedules or statements, is to the best of my      (1) Total Tax Due (Total of Column E)
knowledge and belief, a true and complete report for the period 
stated.                                                             (2) Failure toTimely File Penalty 10% or $50,     
                                                                        Whichever is Greater , For Each Tax Type
Signature                                       Title 
                                                                    (3) Failure to Timely Pay Penalty 10% 
                                                                        For Each Tax Type
Email (required) 
                                                                    (4) Interest (Line 1 x .0049 per month delinquent)

Date                                            Telephone           (5) Discount for Timely Payment of
                                                                        Sales and Lodging Tax
Please Note:                                                        (5% on $100 or less, 2% on over $100,
                                                                            Maximum Discount of $400) 
In accordance with Code Section 40-23-7, returns                    No Discount on Use, Rental or Tobacco Tax 
and remittances are due and payable in monthly 
installments on or before the 20th day of the month                 (6) Net Tax Due (Lines 1-5)          or
next succeeding the month in which the tax                              Delinquent Taxes (Lines 1+2+3+4)
accrues. If the 20th falls on a weekend or holiday, 
the return must be submitted on or before the next                  (7) For Automobile Dealers: Add # of vehicles
                                                                    withdrawn at $1.25 each
working day to be timely filed. 
Per Code Section 41-1-21, failure to make payment                   Total Amount Due & Enclosed 
in a timely manner, or failure to provide such      
evidence of payment in a timely manner, shall                       *Allowable deductions include wholesale sales, auto and machine trade-ins,
subject the affected taxpayer to penalty, interest,                 labor and service, deliveries outside jurisdiction, governmental agencies, gas
and loss of applicable discount.                                    or lube oils, etc.