IF USE TAX RETURN· COMPLETE SCHEDULE B (REVERSE). BEGIN ON LINE 10          CITY OF PUEBLO 
                  IF THIS RETURN INCLUDES SALES FOR MORE THAN ONE LOCATION. COMPLETE 
                  SCHEDULE "C" (REVERSE)                                                      P.O. BOX 1427                                                             COMPUTATION OF 
    GROSS SALES     (TOTAL RECEIPTS FROM CITY ACTIVITY MUST BE REPORTED ANO                   PUEBLO, CO 81002                     719 553-2659                         TAX 
1  ·  AND SERVICE   ~~ieusNl~g :~r ~~R~~:~ =~i~r~iieA~~~L~~:T~~~~~~·                          SA. AMOUNT OF CITY SALES TAX:         LINE 4                   X3.70% 
2A.  ADD: BAD DEBTS COLLECTED                                                                 B.  AMOUNT OF LINE 4 SUBJECT TO LODGERS            TAX:        X4.30% 
2B.  TOTAL LINES 1 & 2A                                                                       C.  ADMISSIONS:                                                X3.00% 
3.  A. ~~~V;~~iis(INCLUDED IN ITEM 1 ABOVE)                                                   D.  MEDICAL MARIJUANA:                                         X4.30% 
                                                                                              6.  ADD: EXCESS TAX      COLLECTED 
                                                                                              7.  ADJUSTED CITY TAX: ADD (LINES     SA,  B.  C, 0, & 6) 
                      (ON WHICH CITY SALES                                                    8.  (LEFT BLANK INTENTIONALLY) 
                      TAX HAS BEEN PAID) 
                                                                                              9.  TOTAL TAX (ITEM 7MINUS        8) 
D   E. TRADE•INS FOR TAXABLE RESALE 
E                                                                                             10. CITY USE  TAX· AMOUNT SUBJECT         TO TAX:              X 3.70% 
D   f. SALES OF GASOLINE ANO CIGARETTE                                                        11.  TOTAL TAX DUE    (ADD  LINES   9 AND 10) 
u 
C 
T                                                                                                       I AT[t IL   NG 
I   H. RETURNED GOODS                                                                              All~E~~~~ND~T~ll~~~N       ADD   INTEREST 1% PER MONTH: 
0 
N   t--------------+------~--;                                                                13. TOTAL TAX, PENAL TY, ANO INTEREST DUE          (ADO LINES  11 AND 12) 
s      PRESCRIPTIONS/PROSTHETICS 
    J. GROCERIES                                                                                   ADJ US I l\1EN f PKIOR Pl RODS   A-ADD: 
                                                                                                   ATTACH COPY OF      OVl R OR 
                                                                                              I    UND[f-ff'AY/..1[NT NOTICF -      B,DEDUCT: 
    K. LODGING OVER 30 DAYS                                                                                                         MAKE CHECK   OR   MONEY     CITY OF 
                                                                                              15. TOTAL DUE AND PAYABLE: 
    L. OTHER                                                                                                                        ORDER     PAYABLE    TO:    PUEBLO 
    3. TOTAL DEDUCTIONS                       (TOTAL OF LINES 3                               Note: Per ordinance a return is mandated to be filed 
                                              ATHROUGHL)                                      regardless if tax is due. Must be recejyed in our office 
4.  TOTAL CITY NET TAXABLE SALES & SERVICE                  (LINE 2B MINUS 
                                                            TOTAL LINE 3)                     by due date. 
                    MO/YR                     DAY      MO   YR  USE FOR ALL REF!'RENCE 
PERIOD                              DUE                         ACCOUNT 
COVERED                             DATE                        NUMBER 

                                                                                                                                                             KEEP THIS COPY 

Cut Here ...................................................................................................................................................................................................................................................................... Cut Here 

                  IF USE TAX RETURN· COMPLETE SCHEDULE B (REVERSE). BEGIN ON LINE 10          CITY OF PUEBLO 
                  IF THIS RETURN INCLUDES SALES FOR MORE THAN ONE LOCATION, COMPLETE 
    ..   ..       SCHEDULE •c•(REVERSE)                                                       P.O. BOX 1427                                                             COMPUTATION OF 
                                                                                              PUEBLO, CO 81002                     (719)553-2659                        TAX 
                                                                                              SA. AMOUNT OF       CITY SALES TAX:   LINE 4                   X3.70% 
2A. ADD: BAD DEBTS COLLECTED                                                                  B.  AMOUNT OF LINE 4 SUBJECT TO LODGERS            TAX:        X4.30% 
2B. TOTAL LINES   1 & 2A                                                                      C.  ADMISSIONS:                                                X3.00% 
3.  A. ~~~v:t~Jiis(INCLUDED IN ITEM 1 ABOVE)                                                  D.  MEDICAL MARIJUANA:                                         X4.30% 
                                                                                              6.  ADO: EXCESS TAX      COLLECTED 
                                                                                              7.  ADJUSTED CITY TAX: ADO        (LINES SA, B, C, 0, & 6) 
                      (ON WHICH CITY SALES                                                    8.  (LEFT BLANK INTENTIONALLY) 
                      TAX HAS BEEN PAID) 
                                                                                              9.  TOTAL TAX (ITEM 7 MINUS 8) 
0   E. TRADE-INS FOR TAXABLE RESALE 
E                                                                                             10. CITY USE TAX· AMOUNT SUBJECT          TO  TAX:             X3.70% 
D   F. SALES OF GASOLINE AND CIGARETTE                                                        11. TOTAL TAX DUE     (ADD     LINES 9AND 10) 
u 
~   G. ~~~~~T:~~Eo6~~~~l~it~:ELIGIOUS AND                                                               LAIE f-lLING 
0 I H. RETURNED GOODS                                                                              A~~t:~~~~ND~/E\~~N         ADD   INTEREST 1 % PER MONTH: 
N 
S      PRESCRIPTIONS/PROSTHETICS                                                              13. TOTAL TAX,      PENALTY, AND    INTEREST  DUE  (ADO LINES  11 AND 12) 
    J. GROCERIES                                                                                   AO~USTMLNT PR OR       PlR ODS   A•ADD: 
                                                                                                   AT JACH COPY Of     OVLR. OR 
                                                                                              I    UNLJ[RPAYMFN I  NOT       C[     B•DEDUCT: 
    K. LODGING OVER 30 DAYS                                                                                                         MAKE CHECK OR MONEY         CITY OF 
                                                                                              15. TOTAL DUE AND PAYABLE: 
    L. OTHER                                                                                                                        ORDER PAYABLE TO:           PUEBLO 
    3. TOTAL DEDUCTIONS                       (TOTAL OF LINES 3                               Note: Per ordinance a return is mandated to be filed 
                                              ATHROUGHL) 
4.  TOTAL CITY NET TAXABLE SALES         & SERVICE          (LINE 2B MINUS                    regardless if tax is due. Must be recejyed in our office 
                                                            TOTAL LINE 3)                     by due date. 
                    MO/YR                     DAY      MO   YR  USE         FOR ALL REFERENCE 
PERIOD                              DUE                         ACCOUNT 
COVERED                             DATE                        NUMBER 

                                                                                                                                                             RETURN THIS COPY 

                                                                            SCHEDULE • B•                        CITYUSE            TAX                                                                                                                                          SCHEDULE •C •CONSOLIDATED ACCOUNTS REPORT 
distributing, or otherwise coosuming in                      Iha City tangible personal property purchased, rented, or leased.                                                                                     than one locatiOn. It muse                            be completely filled 
The use Tax         On:linance impoSela taxequalto the rate shownon                                            Line 5A upon lheprivilegeofusing, storing,                                                          Ttissehedule iS                 required In all cases inwhichoutlheandtaxpayerconveymakeSallInformationa consoidaledrequiredreb.lmin                                                                      accordancewhich includeswilhsalesthecok.rnnmade atheadings.more 
                                                                                                                                                                                                                   If additional space is needed, attach schedule in                                                                            same formal. 
DATE    OF                                                                                                       TYPE  OF       COMMODITY                                                                          ACCOUNT                            BUSINESS ADDRESSES OF                                                                                    PERIODS                        TOTAL GROSS                                   PERIODS NET TAXABLE 
PURCHASE                 NAME OF VENDOR                                ADDRESS                                        PURCHASED                                                    PURCHASE PRICE                  NUMBER                             CONSOLIDATED ACCOUNTS                                                                                            LINE SALES1TOP(AGGREGATEOF        RETURN) TO LINESALES14(AGGREGATETOP OF RETURN)TO 
(A) LIST OF              PURCHASES (IF                             ADDITIONAL SPACE NEEDED· ATTACH                                                SCHEDULE                         IN SAME FORMAT)                                                                                                                                                             $                                                     I                      $                                           I 
                                                                                                                                                                            $                        I                                                                                                                                                                                                               I                                                                  I 
                                                                                                                                                                                                     I                                                                                                                                                                                                               I                                                                  I 
                                                                                                                                                                                                     I                                                                                                                                                                                                               I                                                                  I 
                                                                                                                                                                                                     I                                                                                                                                                                                                               I                                                                  I 
                                                                                                                                                                                                     I                                                                                                                                                                                                               I                                                                  I 
                                                                                                                                                                                                     I                                                                                                                                                                                                               I                                                                  I 
                                                                                                                                                                                                     I                                                                                                                                                                                                               I                                                                  I 
(B) TOTAL PURCHASE PRICE OF                                                 PROPERTY SUBJECT                            TO      CITY USE TAX                                                         I                                                                                                                                                                                                               I                                                                  I 
                    ENTER TOTAL            LINE (B) ON                            LINE 10 ON TOP OF RETURN                                                                  $                        I             ENTER TOTALS                                HERE AND TOP OF RETURN                                                                          S                                                     I                      s                                           I 

                                                                                                    NEW BUSINESS                    DATE 
                                                                                                    MO.               DAY               YR. 
                                                                                                  I  I  I  I                                                          1. If ownership has           changed, give date                 of change and the                                           new                     owne~s name. 
                                                                                                                                                                      2.    If business     has been permanenUy              discontinued,                                           give          date discontinued. 
                                                                                                    DISCONTINUED DATE                                                 3.    If business     location has changed, give new address. 
                                                                                                    MO.               DAY               YR. 
                                                                                                  I              I                  I             I 
                                                                                  SHOW            BELOW CHANGE OF OWNERSHIP AND/OR                                                                                 I, hereby certify.                 under penalty ol perjury,                                            that                 the slatements 
                                                                                  ADDRESS,                       ETC.                                                                                              made herein are                    10       lhe besl of my                      knowledge                                    lrue and correct. 
                                                                                                                                                                                                                   BY: 
                                                                                                                                                                                                                   COMPANY: 
                                                                                                                                                                                                                   PHONE: 
                                                                                      BUS.          ADDRESS                                                           MAILING ADDRESS                                                      TITLE                                                                                                               DATE 

Cut Here ..................................................................................................................................................................................................................................................................... Cut Here 

                                                                            SCHEDULE • B • CITY USE TAX                                                                                                                                                                              SCHEDULE • C • CONSOLIDATED ACCOUNTS REPORT 

distrrbubng.The Use TaxorOrdinanceothefwiseimposesconsuminga taxin equalthe Citytotangiblethe ratepersonalShownonpropertyLine SApurchased.uponthe privilegerented,oforusing,leased.storing,                        IfThisthanadditionalscheduleone location.space kl requiredItIsneeded,mustinbeallcompletefyattachcasesac:hedulein whichfilled outinlhesameandlaxpayerconveyfonnat.makesall informationaconsolidatedrequiredreturnin 8000ldancewhich lnek,de1withaa'9Slhecolt.mnmade atheadings.more 
DATE    OF                                                                                                       TYPE OF        COMMODITY                                                                          ACCOUNT                            BUSINESS ADDRESSES OF                                                                                            PERIODS                TOTAL GROSS                                   PERIODS NET TAXABLE 
PURCHASE                 NAME OF VENDOR                                ADDRESS                                        PURCHASED                                                    PURCHASE      PRICE             NUMBER                             CONSOLIDATED ACCOUNTS                                                                                            SALES(AGGREGATETO  SALES(AGGREGATETO 
                                                                                                                                                                                                                                                                                                                                                                       LINE 1TOP              OF         RETURN)  LINE14                                          TOP OF RETURN) 
(A) LIST OF              PURCHASES (IF ADDITIONAL SPACE NEEDED· ATTACH SCHEDULE                                                                                                    IN SAME FORMAT)                                                                                                                                                             s                                                     I                      s                                           I 
                                                                                                                                                                            $                        I                                                                                                                                                                                                               I                                                                  I 
                                                                                                                                                                                                     I                                                                                                                                                                                                               I                                                                  I 
                                                                                                                                                                                                     I                                                                                                                                                                                                               I                                                                  I 
                                                                                                                                                                                                     I                                                                                                                                                                                                               I                                                                  I 
                                                                                                                                                                                                     I                                                                                                                                                                                                               I                                                                  I 
                                                                                                                                                                                                     I                                                                                                                                                                                                               I                                                                  I 
                                                                                                                                                                                                     I                                                                                                                                                                                                               I                                                                  I 
(B) TOTAL PURCHASE PRICE                                           OF       PROPERTY SUBJECT TO                                 CITY USE TAX                                                         I                                                                                                                                                                                                               I                                                                  I 
                       ENTER TOTAL LINE (B)                            ON LINE                    10 ON TOP           OF        RETURN                                      $                        I             ~NTER TOTALS                                        HERE AND TOP                                        OF RETURN                           $                                                     I                      $                                           I 

                                                                                                    NEW BUSINESS                    DATE 
                                                                                                    MO.               DAY               YR. 
                                                                                                  I              I  I                             I                   1.    If ownership         has changed, give date of change                                                and               the new ownefs name. 
                                                                                                    DISCONTINUED DATE                                                 3.2.  IfIfbusinessbusiness haslocationbeenhespermanentlychanged, givediscontinued,new address.give date discontinued. 
                                                                                                    MO.               DAY               YR. 
                                                                                                  I              I                  I             I 
                                                                                  SHOW BELOW CHANGE OF OWNERSHIP AND/OR                                                                                            I, hereby certify, under penally of perjury, thal                                                                            the slatemenls 
                                                                                  ADDRESS, ETC.                                                                                                                    made herein are to the best of my knowtedge true and correcl. 
                                                                                                                                                                                                                   BY: 
                                                                                                                                                                                                                   COMPANY: 
                                                                                                                                                                                                                   PHONE: 
                                                                                              BUS. ADDRESS                                                            MAILING ADDRESS                                                      TITLE                                                                                                               DATE