CITY OF HOPEWELL, VIRGINIA
FOOD & BEVERAGE TAX FILING FORM
P.O. Box 1604
Hopewell, Virginia 23860
PHONE: (804) 541-2237 FAX: (804) 541-2207
Debra K. Reason, Master Commissioner of the Revenue
Trade Name: ____________________________________
Owner’s Name: __________________________________
Address: _______________________________________
City/State/Zip: ___________________________________
PAYMENT DUE: ___________________
TAX YEAR: _______________________
RETURN ENTIRE FORM
Taxes must be reported and submitted by the 20th of the month following the month of collection. If any
person shall fail or refuse to remit the taxes collected, as required by this article, there shall be added to
such taxes a penalty in the amount of ten (10) percent thereof, or the sum of ten dollars ($10.00),
whichever shall be greater; provided, however, that the penalty shall in no case exceed the amount of tax
due; and interest thereon at the rate of ten (1) percent per annum, which shall be computed upon the
taxes and penalty form the first day of the month in which such taxes are due to be remitted.
ACCOUNT #: ____________________ FOR MONTH OF: ______________________
GROSS MEAL RECEIPTS................................. $_________________________
*GROSS RECEIPTS EXEMPTIONS………….. $_________________________
TOTAL MINUS EXEMPTIONS…………….…… $_________________________
6.0% TAX ON MEALS........................................ $_________________________
PENALTY & INTEREST (SEE ABOVE)............. $_________________________
TOTAL REMITTANCE........................................ $_________________________
Pursuant to VA Code § 58.1-3906 Any corporate, partnership or limited liability company officer who
willfully fails to pay, collect, or truthfully account for and pay over any local admission, transient
occupancy, food and beverage, or daily rental property tax administered by the commissioner of revenue
or other authorized officer, or willfully attempts in any manner to evade or defeat any such tax or the
payment thereof, shall, in addition to other penalties provided by law, be liable for a penalty of the amount
of the tax evaded or not paid, collected, or accounted for and paid over, to be assessed and collected in
the same manner as such taxes are assessed and collected.
____________________________________________________________________________________
SIGNED DATE
VALID ONLY FOR AMOUNT RECEIPTED BY TREASURER
*Exemptions will not be allowed without proper documentation attached
