City ofCity of 
                                                           FINANCE DEPARTMENT
                                                           SALES TAX DIVISION                       SALES/USE TAX RETURN
                     GoldenGolden

Account Number:                                               Period Covered:                                                        Due      
                                                                                                    REMIT TO:  CITY OF GOLDEN
                                                                                                    P.O. BOX 5885,  DENVER, CO 80217-5885
                                                                                                    TEL: 303-384-8023
                                                                                                                CHECK HERE FOR BUSINESS CLOSURE/ 
                                                                                                       CHANGE OF OWNERSHIP (complete page 2)
                                                                                                                CHECK HERE IF CHANGE OF ADDRESS 
                                                                                                       (complete page 2)

  1     Gross Sales and Service — Total receipts from city activity must be reported and accounted for in every 
        return. Include all sales, rentals, leases and all services, both taxable and untaxable.                              1               .        
  2 A   Add bad debts collected                                                                                               2A              .        
    B   Total lines 1 and 2A                                                                                                  2B              .        
  3 A   Non-taxable service sales                                                                                             3A              .        
    B   Sales to other licensed dealers for purposes of taxable resale                                                        3B              .        
    C   Sales shipped out of city and/or state (included in item 1 above)                                                     3C              .        
    D   Bad debts charged off (on which city sales tax has been paid)                                                         3D              .        
    E   Trade-ins for taxable resale                                                                                          3E              .        
    F   Sales of gasoline and cigarettes                                                                                      3F              .        
    G   Sales to governmental, religious and charitable organizations                                                         3G              .        
   H    Returned goods                                                                                                        3H              .        
    I   Prescription drugs/prosthetic devices                                                                                 3I              .        
    J   Other deductions (list):                                                                                              3J              .        
    K                                                                                                                         3K              .        
    L                                                                                                                         3L              .        
  3     TOTAL DEDUCTIONS (Totals of lines 3A through 3L)                                                          3 TOTAL                     .        
  4     TOTAL CITY NET TAXABLE SALES AND SERVICES                                                                 4 TOTAL                     .        

COMPUTATION OF TAX
  5     Amount of city sales tax (3% of line 4)                                                                               5               .        
  6     Add excess tax collected                                                                                              6               .        
  7     Adjusted city tax (add lines 5 and 6)                                                                                 7               .        
  8     Unused                                                                                                                 
  9     Unused
 10 A   City use tax: Amount subject to 3% use tax from Schedule A (see side 2)                                               10A             .        
    B   Additional use tax < 3% (see side 2, Schedule B)                                                                      10B             .        
  11    TOTAL TAX DUE (add lines 7, 10A and 10B)                                                                              11              .        
  12    Late filing: If return is filed after due date, add      Penalty: 10% penalty or $15, whichever is greater              12              .         
                                                                                                 Interest per month 1%        12              .        
  13 A  Add: Prior period adjustment                                                                                          13A             .        
    B   Subtract: Prior period adjustment                                                                                     13B             .        
  14    TOTAL DUE (Make your check or money order payable to the City of Golden)                                 14 TOTAL                     .        

I hereby certify under penalty of perjury, that the statements made herein are, to the best of my knowledge, true and correct.
X                                                                                                                                            
   Name                                                       Title                                                 Date
                                                                                                                                             
   Company                                           Phone 

                                                                        USE TAX
The Golden Municipal Code imposes a tax upon the privelege of using, storing, distributing or otherwise consuming in the City tangible prop-
erty or taxable services purchased, rented or leased. 
A credit is given for taxes paid to other municipalities if the property was not delivered to the business in Golden.

  SCHEDULE A:      CITY USE TAX AT 3%                    For purchases where no city tax was paid                                                                      
  Date of Purchase Name of Vendor/Address                Type of Commodity Purchased                                                               Purchase Price      
                                                                                                                                                                       
                                                                   Total Purchase Price of Property subject to City 3% Use Tax                     $                  .          
                                       Enter here and on line 10A of return                                     Total tax at 3%                    $                  .          

  SCHEDULE B:      CITY USE TAX AT < 3%                  For purchases where city tax of less than 3% was paid                                                         
  Date of Purchase Name of Vendor/Address                Type of Commodity Purchased                                                               Purchase Price      
                                                                                                                                                                       
                                                                   Total Purchase Price of Property subject to City 3% Use Tax                     $                  .          
                                                                                                                Total tax at 3%                    $                  .          
                                                                     Credit for taxes paid to other municipalities Tax Credit                      $                  .          
                                       Enter here and on line 10B of return                             Total tax at varying rates < 3%            $                  .          

  SCHEDULE C:      CONSOLIDATED ACCOUNTS REPORTS                                                                                                                       
  This schedule is required in all cases in which the taxpayer makes a consolidated return which includes sales made at more than one location. It must be completely 
  filled out and convey all information required in accordance with the column heading. If additional space is needed, attach a schedule in the same format. 
                                                                                                                                                                       
  Account Number   Business Address of Consolidated Accts.       Period’s Total Gross Sales               Period’s Net Taxable Sales               Period’s Use Tax    
                                                                 (aggregate to line 1, front of return)   (aggregate to line 4, front of return)   (aggregate to line 10A/B of return) 
                                                                                                                                                                       
                                       Aggregate Totals          $                   .                    $           .                            $                  .          

   New Business Date                                            Show change of ownership and/or business address: 
                                                                                                                                                                     
   Mo         Day    Year                                                                                                                                            
                                                                                                                                                                             
   Discontinued Date 
                                                          MAILING ADDRESS (Check if different                                                                         
   Mo         Day    Year                                 and show address for notices)                                                                               
                                             

1  If ownership has changed, give date of change and new owner’s name   
2  If business has been permanently discontinued, give date discontinued   
3  If business location has changed, give new address   
4  Records are kept at what address?   
5  If business is temporarily closed, give dates to be closed   
6  If business is seasonal, give month(s) of operation   
7  If the return includes sales for more than one location, refer to and complete Schedule C