Remit To: City of Oakland, SSBT c/o MuniServices
1714 Franklin St. #100-292
• Oakland, CA 94612
Sugar-Sweetened Beverage Tax
City of Oakland, CA
Step 1 of 3: Check all that apply:
□ My business delivers items taxable by the Sugar-Sweetened Beverage Tax to retailers in the City of Oakland.
□ My business brings items taxable by the Sugar-Sweetened Beverage Tax into the City of Oakland for retail sale at
our own store.
□ My business is not responsible for paying the Sugar-Sweetened Beverage Tax to the City of Oakland because
(Check one):
□ My business is not subject to taxation by the City of Oakland, under state or federal law.
(Please provide supporting documentation.)
□ My business had annual gross receipts under $100,000 during the most recent calendar year.
(Please provide supporting documentation.)
□ My business has all of its items taxable by the Sugar-Sweetened Beverage Tax delivered by other
distributors**. (Please provide distributor information on the back of this form.)
□ My business does not distribute any items taxable under the Sugar-Sweetened Beverage Tax, and no
distributors deliver these items to my business. (See taxable items and exemptions in FAQs.)
□ My business has closed or does not do business in the City of Oakland.
Effective Date: ___________________
If business was sold, please provide the new owner’s contact information:
______________________________________________ Date Sold: ______________________
Step 2 of 3: Please provide the below information for your business:
Business Name: ___________________________________________________________________________________
Doing Business As (DBA): ___________________________________________________________________________
Mailing Address: __________________________________________ ________________ ______________ ________
Street Address/PO Box City State Zip
Physical Address in Oakland: ________________________________ ________________ _____________ _________
Street Address City State Zip
Business Contact/Title: ______________________________________________________________________________
(Please print.)
Contact Phone #: ___________________________ Contact Email Address: ___________________________________
FEIN or Owner’s SSN #: _____________________________ City of Oakland Business License #: __________________
MUST COMPLETE REVERSE SIDE BEFORE REMITTING
Toll-Free Phone: (866) 240-3665
Toll-Free Fax: (855) 219-4338
Se habla español.
Email:
OaklandBevTaxSupport@muniservices.com
