Charlottesville Meals Tax

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Tax Year: Tax Month:

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Business Information

1) Tax ID

2) Address:

City State Zip Code

3) Contact

Name		Title
Phone		Email

Legal Business Name	Trade Name	Account Number


Business Location Address

Meals Tax Information
1) Monthly Gross Food & Beverage Sales for month ending: :		$
2) Exempt Sales* (Please include documentation to support exempt sales)		$
3) Net Taxable Food & Beverage Sales:	LINE 1 (-) LINE 2	0.00
4) Tax Due:	LINE 3 (X) 6%	0.00
5) Discount if filed and paid on or before:	LINE 4 (X) 3%	(0.00)
6) Tax less discount:	LINE 4 (-) LINE 5	0.00
7) Penalty for Late Payment:	LINE 4 (X) 5%, MINIMUM $2.00	0.00
8) Interest:	10% PER ANNUM OF LINE 4 + LINE 7	0.00
9) Total Tax, Penalty, and Interest Due	SUM OF LINES 6, 7, & 8	$0.00
REQUIRED: An itemized list/summary of the exempt sales OR copies of the receipts supporting the exempt sales claimed on line 2 must be provided with each monthly return in order for the exempt sales to be excluded from taxation. If paying Meals Tax with check: Please mail documentation to support exempt sales with this filing form and check payable to: City of Charlottesville, P.O. Box 2964, Charlottesville, VA 22902-2964* If paying Meals Tax online: Please e-mail documentation to support exempt sales to CORonlinepayment@charlottesville.gov
Comments:
Please explain why you are amending your filing in the Comments section above.

Pursuant to VA Code § 58.1-3906 Any corporate, partnership or limited liability company officer who willfully fails to pay, collect, or truthfully account for and pay over any local admission, transient occupancy, food and beverage, or daily rental property tax administered by the commissioner of revenue or other authorized officer, or willfully attempts in any manner to evade or defeat any such tax or the payment thereof, shall, in addition to other penalties provided by law, be liable for a penalty of the amount of the tax evaded or not paid, collected, or accounted for and paid over, to be assessed and collected in the same manner as such taxes are assessed and collected.

I declare that the foregoing statement and figures are true, complete, and correct to the best of my knowledge and belief.

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