CITY & BOROUGH OF YAKUTAT 
                                P. O. BOX 160, YAKUTAT, AK 99689 
                              1-907-784-3323 Ext. 106, Fax 907-784-3281 
                                                          cbytaxes@yakutatak.us 
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      ____________________________ 
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                                                                               Quarter Ending: _________________ 
                                                                                Delinquent after: ________________ 
                      DISREGARD ITEMS NOT APPLICABLE TO YOUR BUSINESS                              
  SALES                                                                                                
  1. GROSS REVENUE FROM RETAIL SALES…………………………………..                                                    
  2. GROSS REVENUE FROM RENTAL (LODGING, BOAT, AIR B&B ETC)….                                          
  3. GROSS REVENUE FROM SERVICES………………………….……..……..                                                    
  4. LESS EXEMPTIONS CBY CODE 6.40.030 
      EXEMPTION LOG MUST BE ITEMIZED AND ATTACHED TO RETURN..                                          
  5. NET TAXABLE REVENUE………………………………………………………                                                          
  6. COMPUTATION OF TAX 5%........…………………………………………..…                                                  
  7. PENALTY: 5%-1st MOS., 10%-2nd MOS., 15%-3rd OR MORE MOS. LATE….…                                  
      &INTEREST: 15% ANNUALLY: (tax X 15% ÷ by 365 X # of days delinquent.      )                      
  8. DISCOUNT: 4% OF TAX OR $100.00 MAXIMUM (Whichever is less)  
      Only allowed if account is complete and up to date.                                              
  9.  TOTAL SALES TAX REMITTED……………………………………………..……………………                                               
  TRANSIENT ACCOMMODATION (BED)                                                                        
  1. GROSS REVENUE FROM LODGING.(INCLUDING AIR B&B ETC)…......                                         
  2. LESS EXEMPTION CBY CODE 6.52.040 
      EXEMPTION LOG MUST BE ITEMIZED AND ATTACHED TO RETURN..                                          
  3. NET TAXABLE REVENUE………………………………………………………                                                          
  4. COMPUTATION OF TAX 8%…………………………………………………...                                                       
  5. PENALTY: 5%-1st MOS., 10%-2nd MOS., 15%-3rd MOS. OR MORE LATE….…                                  
       &INTEREST:15% ANNUALLY:  Tax X 15% ÷ by 365 X # of days delinquent       ).                     
  6.  TOTAL ACCOMMODATION TAX REMITTED………………………………..                                         ………………..   
  VEHICLE RENTAL                                                                                       
  1. GROSS REVENUE FROM VEHICLE RENTAL……………….……………...                                                  
  2. LESS EXEMPTION CBY CODE 6.52.040 
      EXEMPTION LOG MUST BE ITEMIZED AND ATTACHED TO RETURN                                            
  3. NET TAXABLE REVENUE……………..……………………………………….                                                        
  4. COMPUTATION OF TAX 8%……………….…………………………………..                                                       
  5. PENALTY: 5%-1st MOS., 10%-2nd MOS. 15%-3rd MOS. OR MORE LATE…….                                   
      &INTEREST:15% ANNUALLY: ( Tax X 15% ÷ by 365 X # of days delinquent)                             
  6. TOTAL VEHICLE RENTAL REMITTED……………………………………………………………                                               
  
GRAND TOTAL COMBINED TAXES PAID..................................................................…...______________ 
   
  I declare, subject to penalties prescribed in the Code of the CBY that this return (including attachments) has been examined by me and to the 
  best of my knowledge and belief is true, correct and complete. Taxes are due one month after the end of each quarter & delinquent thereafter.  
       
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      SIGNATURE                                                                              DATE 
                                                          FOR OFFICE USE ONLY 
      DATE______________ BY________OK AS SUBMITTED_________MORE INFO REQ.___________CHECK #______________ 
      CASH AMT._______________RECEIPT_____________PMT.____________PEN__________%__________DUE____________