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City
of Miami Surcharge Remittance Report |
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City Ordinance 12563 |
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PROPERTY NUMBER |
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PARKING
FACILITY LOCATION: ** Provide in order to post properly.** |
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BUSINESS TAX RECEIPT # |
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CERTIFICATE OF USE # |
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Return for the
month and year of: |
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Please exclude sales tax
and surcharge from all amounts |
SURCHARGE COLLECTIONS DUE: |
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PAYMENT TYPE |
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(A) Total Net Revenue
Collected: |
$ |
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Daily (Visitor/Transient) |
$ |
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(B)
Surcharge Due: [ (A) x .15 =
tax due] |
$ |
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Lease (Monthly) |
$ |
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(C)
Penalty [ (B) x .10] |
$ |
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Validation |
$ |
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(D)
Interest [ (B) x .01 x # of months late] |
$ |
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Event |
$ |
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(E)
Total Penalty and Interest: [ (C) + (D) ] |
$ |
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Meter/Coin |
$ |
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Other ( ) |
$ |
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Total to be paid with this return (B) + (E) |
$ |
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Total |
$ |
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Please indicate month for penalty & interest |
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REMITTER'S
NAME AND MAILING ADDRESS: |
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if different than current payment |
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I declare that this
declaration has been examined by me and to the |
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best of my knowledge and
belief is a true, correct and complete |
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declaration. |
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A
non-sufficient funds fee will be assessed if a |
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Signature of surcharge payer or agent |
Print Name |
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check
is returned from bank for any reason. |
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( ) |
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Make checks payable to: |
City of Miami |
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Telephone Number |
Date |
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PO Box 862634 |
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Orlando, FL 32886-2634 |
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If you have any questions
please call (305) 571-1951. Copies of
this form & Surcharge Regulations are available at www.MiamiSurcharge.com |
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