TAXPAYERS NAME AND ADDRESS
PERIOD COVERED                    ACCOUNT                              CITY OF FEDERAL HEIGHTS
DUE DATE                          NUMBER                                       SALES TAX RETURN
                                                                       DEPARTMENT OF FINANCE * 2380 W. 90TH AVE.*FEDERAL HEIGHTS , CO 80260
                                                                       COMPUTATION OF TAX
                                                                       5AMOUNT OF CITY SALES TAX: 4% OF LINE 4$
                                                                       6ADD: EXCESS TAX COLLECTED$
                                                                       7ADJUSTED CITY TAX (ADD LINES 5 AND 6)$
1GROSS SALES AND SERVICES 8
      TOTAL RECEIPTS FROM CITY ACTIVITY MUST BE REPORTED9TOTAL SALES TAX$
      AND ACCOUNTED FOR IN EVERY RETURN INCLUDING ALL SALES, RENTALS10
      AND LEASES AND ALL SERVICES BOTH TAXABLE AND NON-TAXABLE$11TOTAL TAX DUE$
2A.ADD: BAD DEBTS COLLECTED$12LATE FILING IF RETURN IS FILED AFTER DUE DATE  ADD: 
2B.TOTAL LINES 1 & 2A$     PENALTY 10% ($15 MINIMUM)$ 
3A. NON TAXABLE SERVICE SALES $     INTEREST 1% PER MONTH$$
B. SALES TO OTHER LICENSED DEALERS FOR THE PURPOSE 13TOTAL TAX, PENALTY AND INTEREST DUE (ADD LINES 11 AND 12)$
     OF TAXABLE RESALE$14ADJUSTMENT PRIOR PERIODSA - ADD$
C.  SALES SHIPPED OUT OF CITY $ATTACH COPY OF OVER/ UNDERPAYMENT NOTICEB - DEDUCT$
D.  BAD DEBTS CHARGED OFF  15TOTAL DUE AND PAYABLE:$
      (ON WHICH CITY SALES TAX HAS BEEN PAID)$MAKE CHECK OR MONEY ORDER PAYABLE TO THE CITY OF FEDERAL HEIGHTS
E.  TRADE-INS FOR TAXABLE RESALE$TELEPHONE 303-428-3526
F.  SALES OF GASOLINE AND CIGARETTES$
G.  SALES TO GOVERNMENTAL, RELIGIOUS 
      AND CHARITABLE ORGANIZATIONS$
H.  RETURNED GOODS$
I.  PRESCRIPTION DRUGS/PROSTHETIC DEVICES$
J.  OTHER DEDUCTIONS (LIST)$
K.$
L.$
 TOTAL DEDUCTIONS (TOTAL OF LINES 3 A THROUGH L)$
4TOTAL CITY NET TAXABLE SALES AND SERVICE (LINE 2B MINUS TOTAL LINE 3)$                                                                     

SCHEDULE A -  CONSOLIDATED ACCOUNTS REPORT

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 headings.  If additional space is needed, attach schedule in same format.

ACCOUNTBUSINESS ADDRESSESPERIOD'S TOTAL GROSSPERIOD'S NET TAXABLE
NUMBEROF CONSOLIDATED ACCOUNTSSALES (TOTAL TOSALES (TOTAL TO 
                                                                               LINE 1 OF RETURN)LINE 4 OF RETURN)
                                                                               $$

ENTER TOTALS HERE AND ON THE RETURN$$

NEW BUSINESS DATE1.  If ownership has changed, give date of change and new owner's nameSHOW BELOW CHANGE OF OWNERSHIP,I hereby certify under penalty of perjury.
MO.    DAY      YEAR2.  If business has been permanentlydiscontinued, give date discontinuedNAME AND/OR ADDRESS ETCthat the statements made herein are to the best
______/______/______3.  If business location has changed, give new addressof my knowledge, true and correct.
4.  Records are kept at what address?__________________________By: _____________________________________________
DISCONTINUED DATE5.  If business is temporarily closed, give date to be closed ________________________________________________ Company________________________________________
MO.    DAY      YEAR6.  If business is seasonal, give months of operation_______________________________________________Phone __________________________________________
______/______/______7.  If this return inlcuded sales for more than one location, refer to and _______________________________________________________________________________________________
     complete Schedule ATitle                                                       Date