A RETURN IS REQUIRED 
                                                              CITY OF CENTENNIAL SALES TAX RETURN                                                          EVEN IF NO TAX IS DUE
Taxpayer Name:
                                                                                                                   Filing Period:
Location Address:                                                                                                  Due Date: (20th of the month 
                                                                                                                   following the end of the reporting 
                                                                                                                   period)
City, State, Zip
                                                                                                                   Centennial License No:
           GROSS SALES AND SERVICE       (Total receipts from City activity must be 
1.         reported and accounted for in every return including sales, rentals and            5.   AMOUNT OF CITY SALES TAX (Line 4 x 2.5%)
           leases and all services both taxable and non-taxable)
           A. ADD: BAD DEBTS COLLECTED                                                        6. ADD: EXCESS TAX COLLECTED
2.
           B. TOTAL (Add Lines 1 and 2A)                                                      7.  ADJUSTED CITY SALES TAX (Add Lines 5 and 6)
3.         A. NON-TAXABLE SERVICE SALES                                                           DEDUCT VENDOR ALLOWANCE
                                                                                              8.   IF PAID BY DUE DATE (Line 7 x 3%)
           B. SALES TO OTHER LICENSED                                                              Maximum Allowance = $200
              DEALERS FOR RESALE                                                                  Minimum Allowance = $3.00
           C. SALES SHIPPED OUT OF CENTENNIAL                                                 9.  TOTAL TAX DUE     (Line 7 minus line 8)
                                                                                                                   (a) PENALTY = GREATER OF $15 OR 15% ON
           D. BAD DEBTS CHARGED OFF                                                                  LATE FILING - TAX DUE (Line 9)
           E.                                                                                 10. IF FILED AFTER   (b) INTEREST = 1.5% PER MONTH ON TAX 
              TRADE-INS FOR TAXABLE RESALE                                                        DUE DATE ADD:    DUE (Line 9 x 1.5%)
           F. SALES OF GASOLINE AND CIGARETTES                                                11. TOTAL TAX, PENALTY, AND INTEREST DUE 
                                                                                                  (Add lines 9 and 10(a) and 10(b))
           G. SALES TO GOV'T, RELIGIOUS, AND                                                      A. ADD: (PRIOR PERIOD ADJUSTMENT)
              CHARITABLE ORG.
DEDUCTIONS                                                                                    12.
           H. RETURNED GOODS                                                                      B. DEDUCT: (PRIOR PERIOD ADJUSTMENT)
              PRESCRIPTION DRUGS /
           I. PROSTHETIC DEVICES                                                                                   If this amount is $10 or less, you may record 
                                                                                                     TOTAL DUE     the amount due and carry the amount forward 
           J. FOOD                                                                            13.  AND PAYABLE     for payment on a future return when the 
                                                                                                                   threshold of $10 has been reached.
           K. OTHER DEDUCTIONS (LIST)
           L.
                                                                                                                 MAKE CHECK OR MONEY ORDER PAYABLE TO:
           M.  TOTAL DEDUCTIONS (Total of Lines 3A through 3L)
                                                                                                                           CITY OF CENTENNIAL
4.         NET TAXABLE SALES & SERVICE    (Subtract line 3M from 2B)
SCHEDULE A - SPECIAL MESSAGE TO / FROM THE CITY

                             SCHEDULE B                                                       SCHEDULE C-CONSOLIDATED ACCOUNTS
DO NOT COMPLETE THIS SECTION - NOT CURRENTLY IN USE BY THE           This schedule is required in all cases in which the taxpayer makes a consolidated return which includes sales made at more than one 
                             CITY OF CENTENNIAL                      location.  It must be completely filled out and convey all information required   in accordance with the column headings.  If additional space is 
                                                                     needed attach schedule in same format.  Attach a supporting schedule that details lines 1, 2, 3, and 4 on Schedule A for each location.
                                                                                   CENTENNIAL BUSINESS LOCATION ADDRESS             PERIOD'S TOTAL GROSS               PERIOD'S NET
                                                                                   LICENSE NO                                              SALES                        TAXABLE SALES

                   NOT APPLICABLE

                                                                                                                                    LINE 1                       LINE 4
                                                                                   ENTER TOTAL HERE AND IN LINES 1 AND 4 ABOVE
                   NEW BUSINESS DATE:                                                 CHANGE OF LOCATION ADDRESS                           CHANGE OF MAILING ADDRESS
           MONTH                  DAY                           YEAR Address 1:                                    Address 1:
                                                                     Address 2:                                    Address 2:
                   DISCONTINUED DATE:                                City/State/Zip:                               City/State/Zip:
           MONTH                  DAY                           YEAR Phone:                                        Phone:
                                                                     Contact Person:                               Contact Person:
I HEREBY CERTIFY UNDER PENALTY OF PERJURY, THAT THE STATEMENTS MADE HEREIN ARE, TO THE BEST OF MY KNOWLEDGE, TRUE AND CORRECT.
Signature:                                                                                                                          Date:
Printed Name:                                                        Title:                       Phone:                            Email:
                             PLEASE REMIT TO: CITY OF CENTENNIAL, REMITTANCE CENTER, P.O. BOX 17383, DENVER, CO 80217-0383
              Rev 10/20/2014 FOR QUESTIONS, PLEASE VISIT OUR WEBSITE AT www.centennialco.gov  OR CALL 303.325.8000