Account #:                                    Due Date:                                   CITY OF NORTHGLENN                                      
Period Covered:                                                                                                                                   
                                                                                           Sales and Use Tax Return 
  Vendor’s Name & Address 
                                                                                           PO Box 5305 
                                                                                           Denver, CO 80217-5305 
                                                                                           Phone: 303-450-8729  
                                                                                           Fax: 303-450-8708 
                                                                                           salestax@northglenn.org 
1 Gross Sales & Service:                                                                6 Northglenn Sales Tax (Line 5 x 4.0%) =                           
2 Add: Bad Debts Collected:                                                               Food for Home Consumption    
                                                                                       7                                                                   
                                                                                          Subject to Tax                               x 3.0% = 
3 Total Lines 1 & 2:                                                                   
                                                                                          Admissions  
                                                                                       8                                                                   
4 A. Non-Taxable Service Sales                                                            Subject to Tax                               x 3.0% = 
  B. Sales For Resale                                                                     Accommodations  
                                                                                       9                                                                   
D  C. Shipped Out of City/State                                                           Subject to Tax                                x 5.0% = 
E D. Bad Debts: City Sales Tax Paid                                                    10 Marijuana & Marijuana products                x 4.0% =           
D E. Trade-Ins for Taxable Resale                                                      11 Excess Tax Collected                                             
U 
  F. Sales of Gas & Cigarettes                                                         12 Adjusted Tax (Add Lines 6, 7, 8, 9, 10, and 11)                  
C 
T G. Government, Religious, &                                                             Vendors Fee: Deduct 1% of Line 12 (ONLY IF PAID 
                                                                                       13                                                                  
I      Charitable                                                                         BY DUE DATE) 
O H. Returned Goods                                                                    14 Total Sales Tax (Line 12 minus Line 13)                          
N  I.  Prescriptions, Prosthetic Devices                                                  City Use Tax (Attach Schedule)   
                                                                                       15                                                                  
S  J. Food for Home Consumption                                                           Subject to Tax                               x 4.0%= 
  K. Other Deductions, List Separately                                                 16 Total Tax Due:  (Add lines 14 & 15)                              
  L.                                                                                      Penalty (If Filed After the Due Date)                            
                                                                                       17 
  M.                                                                                      15%  of Line 16 (0.15 x Line 16) 
                                                                                          Interest (if Filed After the Due Date) 0.50% per Month 
  TOTAL DEDUCTIONS:                                                                    18                                                                  
                                                                                          (0.005 x # of Mos. x Line 16) 
                                                                                          Total Tax, Penalty, & Interest  
5 NET TAXABLE SALES:                                                                   19                                                                  
                                                                                          (Add Lines 16, 17, 18) 
I hereby Certify under penalty of perjury, that the Statements made herein are to the     Adjustment from Prior Periods  
                                                                                       20                                                                  
best of my knowledge, true, & correct.                                                    (Attach Copy of Assessment) 
Signed:                                                                                    A.  Add                                                         
                                                                                           B.  Deduct                                                      

Company:                                                                               21  TOTAL DUE & PAYABLE                                             
                                                                                           Show Below Change of Ownership and/or Address, Phone, Etc. 
Title:                                                                                  

Phone: 
If Business Closed, please state so and include the closing Date: 
                                                                                                     Mailing Address                    Business Address 
BUSINESS TAX LICENSE IS NOT TRANSFERABLE