Video Gaming

Amusement Push Tax

Please complete the following information to remit as a tax collector with the City of Woodstock to collect the one cent ($0.01) tax upon the amusement of playing a video gaming terminal within the City pursuant to Ordinance 21-0-61 dated October 31, 2021.
Please complete for each individual location.
Submission Date*field type date

Video Gaming Terminal Operator Information

Owner or Corporate Name*field type single line
Input blocked. Maximum character limit of 4000 characters reached.
Address*field type address
Street Address
Address Line 2
City
State
Postal / Zip Code
Country
Contact Name*field type single line
Input blocked. Maximum character limit of 4000 characters reached.
Contact Email*field type email
e.g. example@domain.com
Contact Phone*field type single line
e.g. xxx-xxx-xxxx
Input blocked. Maximum character limit of 4000 characters reached.

Location Information

Business Name*field type single line
Input blocked. Maximum character limit of 4000 characters reached.
City License Number*field type single line
e.g. VG-xx-xx(x)
Input blocked. Maximum character limit of 4000 characters reached.
State License Number*field type single line
e.g. xxxxxxxxx
Input blocked. Maximum character limit of 4000 characters reached.
Collection Month*field type drop-down
Tax Year*field type drop-down

Calculate Number of Terminal Pushes

State ID - Terminal 1*field type single line
Input blocked. Maximum character limit of 4000 characters reached.
Terminal 1 Pushes*field type number
State ID - Terminal 2*field type single line
Input blocked. Maximum character limit of 4000 characters reached.
Terminal 2 Pushes*field type number
State ID - Terminal 3*field type single line
Input blocked. Maximum character limit of 4000 characters reached.
Terminal 3 Pushes*field type number
State ID - Terminal 4field type single line
Input blocked. Maximum character limit of 4000 characters reached.
Terminal 4 Pushesfield type number
State ID - Terminal 5field type single line
Input blocked. Maximum character limit of 4000 characters reached.
Terminal 5 Pushesfield type number
State ID - Terminal 6field type single line
Input blocked. Maximum character limit of 4000 characters reached.
Terminal 6 Pushesfield type number

Tax Calculation

Total Terminal Pushesfield type number
City Tax Ratefield type currency
$
City Tax Owedfield type currency
$
Late Return?*field type radio button
Late Return?YesNo
Number of Months Late*field type number
Late Penaltyfield type single line
Input blocked. Maximum character limit of 4000 characters reached.
Total Late Feefield type currency
$
Total Tax Duefield type currency
$
Supporting Documentationfield type file upload
Drop files here
You have reached the maximum file limit: .
Payment Option*field type radio button
Payment OptionACH PaymentCheck
ACH Routing Numberfield type single line
Input blocked. Maximum character limit of 4000 characters reached.
ACH Account Numberfield type single line
Input blocked. Maximum character limit of 4000 characters reached.
Tax Type Codefield type single line
Input blocked. Maximum character limit of 4000 characters reached.
Under penalties of perjury and other penalties provided by law, I declare 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.*field type checkbox
Under penalties of perjury and other penalties provided by law, I declare 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.I Accept
Signature*field type signature
Printed Name*field type single line
Input blocked. Maximum character limit of 4000 characters reached.
Title*field type single line
Input blocked. Maximum character limit of 4000 characters reached.