PERIOD COVERED                                             ACCOUNT NUMBER
DUE DATE                                                                                                                                                                                   TOWN OF BRECKENRIDGE
                                           TAXPAYER NAME AND ADDRESS                                                                                                                        SALES TAX RETURN
                                                                                                                                                                    FINANCE DEPARTMENT - TOWN OF BRECKENRIDGE - PO BOX 1517 BRECKENRIDGE, CO 80424
                                                                                                                                                                                                 (970) 453-3182

1. GROSS SALES AND SERVICE *                                                                                                                                                               COMPUTATION OF TAX
2A. ADD: BAD DEBTS COLLECTED                                                                                                                      5. AMOUNT OF TOWN SALES TAX 2.5% OF LINE 4
2B. TOTAL LINES 1 & 2A                                                                                                                            6. AMOUNT OF LINE 4 SUBJECT TO ACCOMODATIONS TAX                          X 3.4% =
3.         A. NON-TAXABLE SERVICE SALES
                                                                                                                                                  8. ADD: EXCESS TAX COLLECTED
           B. SALES TO OTHER LICENSED DEALERS FOR PURPOSES                                                                                        9. TOTAL TAX DUE: (ADD LINES 5, 6, AND 7)
           OF TAXABLE RESALE                                                                                                                      10.  PENALTY 10% (MINIMUM $15.00 PENALTY)
           C. SALES SHIPPED OUT OF TOWN AND/OR STATE                                                                                                      INTEREST (1% PER MONTH)
                                                                                                                                                          MANDATORY PAPER FILING FEE - EFFECTIVE JANUARY 1, 2017   5.00     TOTAL                 5.00
DEDUCTIONS D. BAD DEBTS CHARGED OFF                                                                                                               12. TOTAL TAX AND FEES DUE (ADD LINES 9 AND 10)
                                                                                                                                                  13.  A - ADD
           E. TRADE-INS FOR TAXABLE RESALE                                                                                                                B - DEDUCT
                                                                                                                                                  14. TOTAL DUE AND PAYABLE
           F. SALES OF GASOLINE AND CIGARETTES
           G. SALES TO GOVERNMENTAL, RELIGIOUS, AND 
           CHARITABLE ORGANIZATIONS
           H. RETURNED GOODS                                                                                                                      MAKE CHECK OR MONEY ORDER PAYABLE TO TOWN OF BRECKENRIDGE
           I. PRESCRIPTION DRUGS / PROSTHETIC DEVICES                                                                                                                            SPECIAL MESSAGE TO AND FROM TOWN / TAXPAYER
           J. OTHER DEDUCTIONS                                                                                                                    CHECK HERE FOR PERMANENT BUSINESS CLOSURE / CHANGE OF OWNERSHIP
           TOTAL DEDUCTIONS (A THRU L)                                                                                                            CHECK HERE IS CHANGE OF ADDRESS / PHONE NUMBER / FAX NUMBER
4. TOTAL TOWN NET TAXABLE SALES & SERVICES (2B MINUS 3)                                                                                           *  TOTAL RECEIPTS FROM TOWN ACTIVITY MUST BE REPORTED AND ACCOUNTED FOR IN EVERY RETURN INC. ALL SALES, RENTALS, LEASES AND 
                                                                                                                                                  ALL SERVICES BOTH TAXABLE AND NON-TAXABLE

                               SCHEDULE C - 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                   SHOW BELOW CHANGE OF OWNERSHIP AND/OR ADDRESS, ETC.
must be completely filled out and convey all information required in accordance with the column headings.

           ACCOUNT NUMBER      BUSINESS NAME (OF           TOTAL GROSS SALES                             PERIODS NET TAXABLE 
                               CONSOLIDATED ACCOUNTS)      (AGGREGATE TO LINE 1 OF RETURN)               SALES (AGGREGATE TO LINE 4 
                                                                                                              OF RETURN)

                                                                                                                                                                                                 BUSINESS ADDRESS ?
                                                                                                                                                                                                 MAILING ADDRESS ?

                                                                                                                                                  I HEREBY CERTIFY UNDER PENALTY OF PERJURY THAT THE STATEMENTS MADE HEREIN ARE TO THE BEST OF MY 
                                                                                                                                                  KNOWLEDGE, TRUE AND CORRECT.
                                                                                                                                                  BY
                                                                                                                                                  TITLE
                                                                                                                                                  COMPANY
           ENTER TOTALS HERE AND ON TOP OF RETURN                                                                                                 PHONE