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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 and Marijuana products x 2.0% =
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)
A. Add
Signed:
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
