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6. Excess Tax Collected (see instructions) 7. Sub-Total of Sales Taxes: Important Message ( Line 5 plus line 6) 8. Vendor Fee: (line 7 times Max = $200, Enter on Late Return 9. Net Broomfield City and County Sales Tax: (line 7 minus line 8) 10. Lodging Tax: Balance due from Lodging Tax Return (Attach copy of return) 1. GROSS SALES & SERVICES: (Round to even 11. Special District Tax: For businesses located in special district ONLY 1 a. ADD - Bad Debts Collected: Arista Local Improv. Dist. (ALID) (which were previously deducted) 2. Adjusted Gross Sales & Services: 12. Late Filing Penalty: (Line 1 plus 1a) ( See Instructions) 3. Exemptions: 13. Interest: (Please insert total of line 3 from page 2 ) ( See Instructions) 4. Net Taxable Sales & Services: 14. Adjustments: See Instructions (Line 2 minus line 3 ) ( Attach Authorization Letter) 5. Broomfield City and County 15. Total Due and Payable: Sales Tax: (Add Line 9 through line 13) ( Line 4 multiplied by 4.15%) or (.0415) ( Continued on line 6 ) Business Location Phone: [PHONE REDACTED] Fax: [PHONE REDACTED] Email: [EMAIL REDACTED] Web: www.broomfield.org/salestax Signature: Date: Title: Phone: Fax: Email: Late returns will be assessed a $15 per notice penalty fee for the first & second issuance of the delinquency notice. Assessment penalty fees will be $25/notice or 15% of tax due for the 3rd, 4th and 5th notices, 6th or more $50 per notice or 30% of tax due. City's License Number ( Required ) - If filing a Consolidated Return, OR advising of changes on page 2, please place a LARGE in box at right - Due Date Enter Business or Trade Name: [Minus line 14 if credit is authorized; Plus line 14 if a debit is required] - SALES TAX RETURN You must file this return even if line 15 is zero $ Note: Broomfield, CO 80038-0407 FILING PERIOD (Required) Returns not postmarked by the due date will be late CITY & COUNTY OF BROOMFIELD Sales Tax Administration Division P.O. Box 407 - (Taxable sales) times (.002) Flatiron Improv. Dist. (FID) (Taxable sales) times .01% (.0001) (Total receipts, before sales tax, from City & County activity must be reported including all sales, rentals, leases, & services, both taxable and non- taxable) - Make Check or Money Order Payable to: City and County of Broomfield My signature affirms that I have read this return and it is true and correct to the best of my knowledge and is signed subject to penalties for perjury and other criminal offenses. - - - ---PAGE BREAK--- CITY & COUNTY OF BROOMFIELD Sales Tax Return Page 2 $ $ $ $ $ $ $ $ $ Totals: $ $ $ - - - - - - - SCHEDULE B: CONSOLIDATED ACCOUNT REPORT This schedule is required in all cases where the vendor is reporting sales for more than one location within the City and County of Broomfield. Each location must have a separate license.(Attach a separate spreadsheet if necessary) Account Number Business Location Address Total Gross Sales For Reporting Period Total Exemptions Line 3: Total Exemptions: (Total of Line A though Line N) (Carry amount to line 3 on Page 1) Net Taxable Sales M Miscellaneous exempt sales: (Please explain) Line 3 (Detail) Exempt Sales (See page 3 for instructions) G Exempt Sales: (Government, religious, & charitable organizations) H Returned Goods: (on which tax was previously paid) I Sales of Lottery and Gasoline: Non-Taxable Service or Labor: Sales to Licensed Dealers: (Must support exemption with valid Resale Number) Sales Shipped Out of the City & County of Broomfield: Bad Debts Charged Off: (On which tax was previously paid): Trade-ins: (Where property will be resold at taxable value) J Prescription Drugs, and other exempt medical transactions: K Food purchased with Food Stamps or WIC Vouchers: (Does not include “Food for Home Consumption” sold without stamps or vouchers) (See Instructions) L Sales of Building Materials: (Only when supported by a Building Permit, showing Local Use Tax paid, and the permit number is shown on invoice) A B C D E F Sales of Cigarettes ADDRESS CHANGES: BUSINESS STATUS CHANGES: Mailing address: 1) Ownership (Date, New Owner and Phone) City, State Zip: Location address: 2) Business Closure: (Date) Email: Phone: 3) Filing frequency: (Call or Email for change) ADDRESS CHANGES: BUSINESS STATUS CHANGES: Mailing address: 1) Ownership (Date, New Owner and Phone) City, State Zip: Location address: 2) Business Closure: (Date) Email: Phone: 3) Filing frequency: (Call or Email for change)