Various Governments Pretesting Activites

U.S. DEPARTMENT OF COMMERCE
Economics and Statistics Administration

U.S. CENSUS BUREAU
(8-4-2010)

QUARTERLY
SURVEY OF LOCAL GOVERNMENT TAXES

FORM

F-70

(06-05-2012) Draft 2

OMB No. 0607-0143: Approval Expires 06/30/2014

DUE DATE:

RETURN TO:
U.S. Census Bureau
1201 East 10th Street
Jeffersonville, IN 47132-0001

Need help or have
questions?
• Visit
census.gov/govs/qtax
• Call
1-866-880-9010 weekdays,
7am to 5pm ET
• Email
[email protected]
In correspondence
pertaining to this report,
please refer to the User
ID below the address box.
REPORT ONLINE: It’s fast and secure. Respond
to this survey via the Internet at the following web
address using the supplied User ID and Password:
respond.census.gov/qtax

User ID:
➤
Password:

GENERAL INSTRUCTIONS
1.

Report figures for the last date of the calendar quarter named in the form title.

2.

You may report on either a cash or accrual basis.

3.

PLEASE COMPLETE ALL ITEMS ON THE FORM. If some items do not apply to your system, write ’not
applicable’. If some items may apply but there is a zero dollar amount, then do not leave blank. Enter zero (’0’).

4.

Do not delay reporting to await final figures, if substantially accurate figures can be supplied on a preliminary
basis.

5.

Use a black or blue ball point pen. Do not use pencil or felt-tip pen.

1

Is your addressee title/department and mailing address the same as shown in the address label?
Yes – Go to 2

No – Enter correct information below

Addressee Title or Department

17702010

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Before filling out this form, please read carefully each part and all related definitions and instructions.
Note especially:

ATTN:
Street 1

Street 2

City

State

Zip Code

Please continue on the next page

Page 2

HOW TO
REPORT
DOLLAR
FIGURES

2

CORRECT marking example –
Please print all information clearly in ordinary
characters. (Use care to keep characters in their
respective boxes.)
$Bil.

Mil.

Thou.

Dol.

1 2 3

4 5 6

7 8 0

INCORRECT marking example –
Do not put slashes through "0" or "7".
$Bil.

Mil.

Thou.

Dol.

7

8 9 0

What was the amount of tax collections from all taxes imposed by your government for the quarter
ending
Include
• Taxes collected for your government by another government
• Current and delinquent amounts, penalties, and interest
Exclude
• Receipts from service charges
• Special assessments
• Interest earnings
• Fines
• Any other sources that are not taxes or licenses
A. Property taxes - All taxes on property, real or personal.
Report collections during the fiscal year from all levies for
all funds of your government, and its agencies.
Include
• Levies for debt service
• Levies for contributions to pension funds
• Levies for other funds or purposes
• Special property taxes (e.g., automobiles or intangible
property)
Exclude
• Any taxes you collected on behalf of other governments
• Taxes not measured by value
• Payments in lieu of taxes. . . . . . . . . . . . . . . . . . . . . . T01

Property Taxes
$Bil.

$Mil.

$Bil.

$Mil.

Thou.

Dol.

B. General sales and gross receipts taxes
Include
• Taxes on goods and services, measured as a percent
of sales or receipts, or as an amount per unit sold
(e.g., gallon, package, etc.)
• Only taxes imposed by your government
• Sales and use taxes
• Taxes applicable with only specified exceptions (e.g.,
food and prescribed medicines) to sales of all goods
and services or to all gross receipts, whether at a
single rate or at classified rates
Exclude
• Shares of taxes imposed by another government . . . T09

Tax Revenues
Thou.

Dol.

Form F-70

1.

Local individual income taxes
Include
• Taxes on individuals measured by net income and
taxes on special types of income (e.g., interest,
dividends, income from intangible property, etc.)
Exclude
• Income tax distributions for revenue sharing from
the state or from other governments . . . . . . . . . T40

2.

17702028

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C. Local income taxes

Local corporation net income tax
Include
• Taxes on corporations and unincorporated business
(when taxed separately from individual income),
measured by net income, whether on corporations
in general or on specific kinds of corporations,
such as financial institutions . . . . . . . . . . . . . . . . T41

Please continue on the next page

Page 3

3

Use this space to:
A) Explain any significant changes occurring within the last quarter that would aid in the
understanding of this report;
B) Describe any difficulties you encountered in completing this form;
C) Identify and list all items that are "not applicable" for your government.

4

Who should be contacted to answer questions about data reported on this form?

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Area code and phone number

E-mail Address - Please print

Title of contact person - Please print

Extension

Area code and fax number

Date form was completed
(MM)
(DD)
(YYYY)

Thank you for completing this form.
Retain a copy of the completed questionnaire for your records.
NOTE: The U.S. Census Bureau receives its authorization to conduct this survey from Title 13, United States Code, Section 161. This form has been approved by the Office of
Management and Budget (OMB) and given the number 0607-0143. 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 was not displayed, under the Paperwork Reduction Act, we could not request your participation in this
voluntary survey. Information provided on this questionnaire compiled from or customarily provided in public records are exempt from confidential treatment as cited in Title 13,
United States Code, Section 9.
Please note that this is a national form that applies to governments with wide differences in the size of their service areas, the amount of population served, and the extent and
complexity of their activities. Public reporting burden for this collection of information is estimated to vary from 10 minutes to 1 hour per response, with an average of 20 minutes
per response, including 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 0607-0585, U.S. Census Bureau, 4600 Silver Hill Road, AMSD-3K138, Washington, DC 20233. You may e-mail comments to [email protected]; use Paperwork Project
0607-0143 as the subject.

Form F-70

17702036

Name of contact person - Please print