F-73 Quarterly Survey, Selected Local Taxes

F-73

OMB No. 0607-0112: Approval Expires 04/30/2009
In correspondence pertaining to this report, please refer
to the Census File Number above your address

F-73

FORM
(3-12-2009)

U.S. DEPARTMENT OF COMMERCE
Economics and Statistics Administration
U.S. CENSUS BUREAU

QUARTERLY SURVEY
SELECTED LOCAL
TAXES
RETURN
TO

U. S. Census Bureau
Governments Division
Public Finance Branch B
Washington, DC 20233-6800

Please respond within 30 days to:
http://harvester.census.gov/sgf/f73
OR
Fax 1–866–803–0407

(Please correct any error in name, address, and ZIP Code)

FROM THE ACTING DIRECTOR
U.S. CENSUS BUREAU
We are writing to request information needed for our Quarterly Survey of Tax Collections. The Bureau of
Economic Analysis will use this information to develop estimates of the Gross Domestic Product—a key
economic indicator.
The form on the reverse side shows the data we need from your agency. If actual amounts of sales
and/or income tax collections during the past three months are not available, you may use reasonable
estimates.
Please transmit your report within 30 days via the Internet at .
You may also respond to this survey by mail or fax (toll-free 1 (866) 803-0407).
The U.S. Census Bureau receives its authorization to conduct this voluntary survey from Title 13, United
States Code, Section 182. This form has been approved by the Office of Management and Budget (OMB)
and given the number 0607-0112. Please note the number displayed in the upper right-hand corner of this
form. Display of this number confirms that we have approval from OMB to conduct this survey. If this
number were not displayed, we could not request your participation in this survey.
We estimate that it will take from 10 to 20 minutes to complete this form, with an average of 15 minutes
per response, including the time for reviewing instructions, searching existing data sources, gathering and
maintaining the data needed, and completing and reviewing the collection of information. Send comments
regarding this burden estimate or any other aspect of this collection of information, including suggestions
for reducing this burden, to: Paperwork Project 0607-0112, U.S. Census Bureau, 4600 Silver Hill Road,
AMSD-3K138, Washington, DC 20233. You may e-mail comments to ; use
“Paperwork Project 0607-0112” as the subject.
If you have any questions concerning this request, please call the Governments Division on our toll-free
number, 1 (866) 820-7210.
Thank you for cooperating in this important survey. We are grateful for your help.
Sincerely,

Thomas L. Mesenbourg

USCENSUSBUREAU

❶

What was the total amount of general sales tax, and any
related use tax, collected by your agency for the three (3) months
ending . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$.

.00
T09

Include:
• Taxes applicable with only specified exceptions (e.g., food and prescribed medicines) to sales of all
types of goods and services or to all gross receipts, whether at a single rate or at classified rates
• Sales use taxes
Exclude:
• Taxes imposed distinctively on sales of or gross receipts from selected commodities, services, or
businesses

❷

What was the total amount of payroll, earnings, or personal
income tax collected by your agency for the three (3) months
ending . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$.

.00
T40

Include:
• Taxes on individuals measured by net income and taxes on special types of income (e.g., interest,
dividends, income from intangible property, etc.)
• Combined individual and corporation income taxes where proceeds cannot be separated
Exclude:
• Taxes using income from intangible property as a measure of its value as of assessment date
• Income taxes on unincorporated businesses
• Payroll taxes to finance insurance trusts programs such as Social Security taxes, and city gross
earning taxes

❸

What was the total amount of other taxes collected by your agency for the
three (3) months ending
Type of tax

❹

❺

Value

$

.00

$

.00

$

.00

$

.00

Remarks — Please explain any unusual developments (such as tax rate changes) affecting collections.
Also, please list the type and value of any other taxes not reported in ❸.

CERTIFICATION

Name and title

Telephone
(Area code, number, extension)

FORM F-73 (3-12-2009)