Required fields are marked with asterisks (*)

Prepared Food & Beverage Tax

A COPY OF AN ST-1 OR ST-2 MUST ACCOMPANY THIS FORM.

Month and year for collection

IBT Number for Mt. Vernon location (from ST-1 or ST-2)

Business Name

Business Address

Mailing address

1. Gross taxable sales amount

2. Total amount of tax (multiply #1 by 1%)

3. Penalty amount (2% per month)

4. Total tax and penalty (add #2 and #3)

Is this a FINAL return?

Yes

Upload a copy of the ST-1 or ST-2

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Date

Taxpayer name

Title

Phone Number

Name of person preparing this return.

Name of Firm or Employer

Phone Number

I certify that the information provided is true, accurate, and complete and that the information is taken from the books and records of the business for which this return is filed.

Yes