City of Northglenn 
                                                                       11701 Community Center Drive 
                                                                       Northglenn, CO  80233-8061 
                                                                       Phone:  303-450-8729 
                                                                       Fax:  303-280-4611 
                                                                          
                    INITIAL USE TAX RETURN 
 
This form is to be used by new businesses or organizations located in the City of Northglenn to report initial use 
tax.  Since use tax applies to all businesses and organizations, please make sure to understand the use tax 
explained in the Sales and Use Tax Information Brochure.  If no use tax is due, this return must still be filed.  If the 
initial use tax was reported on a regular sales/use tax already filed, please file this return with a note stating this 
fact.  Please fill out all applicable sections of this return.  Please report all subsequent taxable purchases on the 
regular sales/use tax returns. 

Business Name       

Business Address   

Account Number                             Payment Due Date                 
 
                               Section A:  Startup of a New Business 
 
Itemize all purchases made incidental to the startup of the business for furniture, fixtures, and/or supplies (not 
inventory) that were purchased from a vendor that did not charge a City sales tax on the item (many vendors 
charge State tax but not City tax).  If a vendor charged less than 4% city sales tax, the difference of the tax rates 
must be multiplied by the taxable amount and reported on the “Excess Tax Due” space below. 
 
Invoice Date      Vendor’s Name & Address  Taxable Amount                  4% Tax Due       Excess Tax Due 
                                                                                                             
                                           Section A Totals 
                                                                                                             
                                          (OVER) 

                  Section B:  Purchase of an Existing Northglenn Business 
 
New owners of an existing Northglenn business must pay the 4% use tax on all furniture, fixtures, supplies (not 
inventory), and leasehold improvements listed on the purchase contract. 
 
Purchase Date            Seller’s Name & Address          Purchase Price of Items                 4% Tax Due 

                 Section C:  Leases of Equipment, Fixtures, and/or Furniture 
 
Please list your leases.  Indicate whether the City tax is paid by the lessor or the lessee.  If the lessor does not 
charge City sales tax, the lessee is responsible for paying City use tax for all lease payments going forward on the 
regular sales/use tax returns. 
 
                                                                 Lease Payment           4% Tax Due From 
 Lessor Name                     Lessor Address 
                                                                  Amount                 Lessor     Lessee 

                                   Section C Totals                                                   

  Total amount of lease payments to date where lessor did not charge City sales tax:             

                                                                         4% Tax Due:             
 
                                   Section D:  Total Due 
 
               Line 1:  Total Taxable Amount from Sections A, B, and C     

               Line 2:  Total Tax Due from Sections A, B, and C            

               Line 3:  Penalty (If filed after due date) (Line 2 x 15%)   

                        Interest (Line 2 x 0.5% x number of months late) 
               Line 4: 
                        (If filed after due date)                          

               Line 5:  Total Due (Add Lines 2, 3, and 4)                  
 
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:                                                            Phone Number: