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CITY OF MODESTO UTILITY USERS TAX PREPAYMENT FORM Business: Address: City: Our firm wishes to prepay the maximum Utility Users Tax for calendar year in the amount of $ 1, 500 per individual utility account as follows: Name of Utility Account Number Amount TOTAL (Check Enclosed) Signature: Date: Telephone: Please reply by December 15th Please make checks payable to: City of Modesto Finance Dept. P. O. Box 642 Modesto, CA 95353