CITY OF GOLDEN
                        INITIAL USE TAX RETURN

BUSINESS NAME:                                                  CITY ACCOUNT #

STREET ADDRESS:                                                 BUSINESS START DATE OR BUSINESS PURCHASE DATE
CITY, STATE, ZIP:

Use Tax is due on tangible, personal property that is used, stored or consumed in the City on which:
 
                   a)   no municipal sales tax was paid
                   b)   the municipal tax paid was at a rate less than 3%
                   c)   the property was delivered to Golden and a municipal tax was paid to the wrong city

TO AVOID PENALTY AND INTEREST CHARGES, this return must be properly signed and filed with remittance:
ON OR BEFORE THE 20TH DAY OF THE MONTH FOLLOWING the business start date or business purchase date.

THIS INITIAL USE TAX RETURN MUST BE FILED SEPARATELY FROM YOUR SALES TAX RETURN

Examples of taxable tangible personal property include, but are not limited to, the items listed below.  Circle the
applicable item(s) being reported or attach a detailed listing and enter the total amount on the "Taxable Amount" line.

                                                                                         TAXABLE AMOUNT

 1. Business machines, computers, calculators, printers, copiers, etc.            1.    $

 2. Cash registers, counters, booths, tables, chairs, clothing and shoe
           racks, shelving, display cases, desks, phones, etc.                    2.    $

 3. Food processing equipment, appliances, walk-in coolers, supplies,
           cookware, serving dishes, serving utensils, etc.                       3.    $

 4. Shop equipment and tools, compressors, hyrdraulic and electronic
           equipment and supplies, etc.                                           4.    $

 5. Medical tools, equipment and supplies, etc.                                   5.    $

 6. Signs, outdoor displays, marketing items, shop displays, etc.                 6.    $

 7. Computer software, office supplies, paper, lights, etc.                       7.    $

 8. Vacuum cleaners, cleaning supplies, etc.                                      8.    $

 9. Other items (list):                                                           9.    $

 10. TOTAL TAXABLE AMOUNT                                                         10.  $

 11. TAX DUE                            Taxable Amount from line 10 X 3%          11.  $

 12. Less:  Credit for taxes paid to other municipalities                         12.  $

 13. TAX DUE AFTER CREDIT                                   Line 11 minus line 12 13.  $

 14. Plus Penalty  (If filed after due date)                10%                   14.  $
                                                            minimum of $15.00

 15. Plus Interest (If filed after due date)                1% per month          15.  $

 16. TOTAL DUE                                              Line 13 + 14 + 15     16.  $

I DECLARE UNDER PENALTIES OF PERJURY THAT THE INFORMATION CONTAINED ON THIS FORM IS
TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE.

Signature:                                     Title:                                    Date: 

Mail this return with check payable to: City of Golden,         911 10th Street,         Golden, CO  80401