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2. 
4. Quarterly Amusement Tax Remittance Form
6. Village Code, Section 112.03 provides for the imposition of a tax upon all public amusements or public places of amusement located within the corporate limits of the village in an amount equal to two and one-half (2.5) percent of the gross receipts from the sale of admission tickets to said public amusement or public place of amusement. Further, it is unlawful for any person or other business entity to operate a public amusement or public place of amusement for gain or profit within the corporate limits of the village without payment of the tax specified in this section.
8. Due by the 20th of the month following the quarterly end date.
12. Owner/Corporate Name*
13. Quarterly Liability Period*
15. Address*
    City, State, Zip
17. Is this an AMENDED RETURN?*

    1. Yes
    2. No
19. 1. Gross Receipts from Amusement Activities:*
21. 2. Total Amount of Tax Due (Multiply Line 1 by 2.5%)*
23. 3. Total Amount of Tax Due (Line 1 + Line 2)*
25. 4. Penalty for Late Filing of Tax Return (Multiply Line 3 by 2.0%)**
27. 5. Total Amount of Tax Due Plus Penalty (Line 3 + Line 4)*
29. *Village Code, Section 112.05 states that if for any reason any tax is not paid when due, a penalty at the rate of two percent per month on the amount of tax which remains unpaid shall be added and collected. Taxes are due by the 20th of the month following each quarter (July, October, January and April of each year).
33. Under penalties of perjury and other penalties provided by law, I state that I have examined this return and, to the best of my knowledge and belief, it is true, correct and complete. I further declare that the information set forth is taken from the books and records of the business for which this return is filed.
35. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
37. Paid preparer's signature*
38. Date*
    Date
39. Phone*
41. Taxpayer's signature*
42. Date*
    Date
43. Phone*
45. 
Leave This Blank:


47. 1. Receive an email copy of this form.
48. Email address

    This field is not part of the form submission.

49. Submit

* indicates a required field