Affidavit of Gross Sales Submission Form

2. Restaurants, Cafes, Cafeterias or Eating Establishments who sell Alcoholic Beverages are required to submit this form to the City Secretary's Office.

4. (a) Affidavit. The party or entity operating the business shall, on a monthly basis, on a date coinciding with the date that the same information is furnished to the state, file with the city secretary an affidavit reflecting gross receipts and sales of the business. The affidavit shall contain a statement reflecting the gross sales attributable to food and gross sales attributable to alcoholic and mixed beverages. The affidavit shall contain the address and telephone number of the person executing the affidavit.

   (a) Affidavit. The party or entity operating the business shall, on a monthly basis, on a date coinciding with the date that the same information is furnished to the state, file with the city secretary an affidavit reflecting gross receipts and sales of the business. The affidavit shall contain a statement reflecting the gross sales attributable to food and gross sales attributable to alcoholic and mixed beverages. The affidavit shall contain the address and telephone number of the person executing the affidavit.

6. (b)Tax figures. The party or entity shall also file with the city secretary, on a monthly basis, on a date coinciding with the date that such information is furnished to the state, the gross receipts and figures furnished to the state for sales tax and alcoholic beverage tax purposes. This provision applies to restaurants, cafes, cafeterias or eating establishments and to a permit fee of a federal or state agency.

   (b)Tax figures. The party or entity shall also file with the city secretary, on a monthly basis, on a date coinciding with the date that such information is furnished to the state, the gross receipts and figures furnished to the state for sales tax and alcoholic beverage tax purposes. This provision applies to restaurants, cafes, cafeterias or eating establishments and to a permit fee of a federal or state agency.

8. Business Name:*

9. Please see the link below to fill out the affidavit.
   Affidavit of Gross Sales- Form

   The form will need to be filled out, printed, notarized and uploaded.

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19. 1. Receive an email copy of this form.
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