Unknown Unknown Nomor M Tahun 2012 tentang TAHUN 2012 MARET 2012 PEMUNGUTAN PAJAK HOTEL. PAJAK RESTORAN, HIBURAN. PAJAK PARKIR, DAN PAJAK PENERANGAN JALAN. PAJAK P E M E R I N T A H K O T A S I N G K A W A N G J a l a n . S U R A T K E P U T U S A N K E P A L A DI N A S K O T A S I N G K A W A N G N O M O R : T A H U N T E N T A N G P E N G U K U H A N S E B A G A I WAJI B P A J A K D A E R A H K E P A L A D I N A S . Me m b a c a Menl m b a n g Mengl n g a t Me n e l a p k a n - i s i a n Formulir F o m i u l i r P e n d a f t a r a n y a n g d i s a m p a l k a n k e p a d a Di n a s , P e n d a p a t a n , P e n g e l o l a a n K e u a n g a n d a n A s e t Kot a S i n g k a w a n g Nomor Formulir : t a n g g a l - a . b a h w a y a n g b e r s a n g k u l a n t e l a h m e m e n u h l p e r s y a r a t a n b a l k s u b j e k m a u p u n o b j e k d a e r a h : - b b a h w a s e h u b u n g a n d e n g a n h a l t e r s e b u t p e r l u u n t u k m e n e t a p k a n P e n g u k u h a n b e r s a n g k u t a n menjadi W a j i b P a j a k D a e r a h ; d a n 1. P e r a t u r a n D a e r a h P e m e r i n t a h Kot a S i n g k a w a n g Nomor 11 T a h u n 2010 t e n t a n g Daerah. 2. P e r a t u r a n Walikota S i n g k a w a n g Nomor : ________________ T a h u n 2012 t e n t a n g P e m u n g u t a n Hotel, P a j a k R e s t o r a n , P a j a k Hiburan, P a j a k Parkir, d a n P a j a k P e n e r a n g a n J a l a n . MEMUTLJSKAN - S U R A T KEPUTUSAN K E P A L A DINAS KOTA S I N G K A W A N G TENTANG PENGUKUHAN SEBAGAI WAJIB P A J A K DAERAH P E R T A M A - Meng u k u h k a n N a m a / B a d a n U s a h a A l a m a t U s a h a N o m o r P o k o k Wajib P a j a k Dae r a h ( N P W P D ) N a m a P e n a n g g u n g P a j a k Dae r a h A l a m a t U s a h a K E D U A K E T I G A S e b a g a i Wajib P a j a k D a e r a h - K e p u t u s a n Ini m u l a l b e r l a k u s e j a k t a n g g a l d i t e t a p k a n . - Apabil a d l k e m u d l a n hari t e r d a p a t k e k e l i r u a n d a l a m K e p u t u s a n Ini a k a n d i a d a k a n p e m b e t u l a n s e p e r l u n y a ; D I T E T A P K A N DI P A D A T A N G G A L S I N G K A W A N G K E P A L A S A T U A N K E R J A P E R A N Q K A T DAERAH P a n g k a t NI P WAUKOTA SINGKAWANG t t d HASAN KARMAN S a l i n a n S e s u a i d e n g a n Asl i n y a NIP. 1 9 6 8 1 0 1 6 1 9 9 8 0 3 1 0 0 4 Kepala Bagian Hukym dan Perundang-undangan XASMALYAR SH Pembina p a j a k y a n g P a j a k P a j a k LAMPIRAN PERATURAN WAUKOTA SINGKAWANG : PEMUNGUTAN PAJAK HOTEL PAIAK RESTORAN. PAJAK HIBURAN, PAJAK PARKIR, OAN PAJAK PENERANGAN JALAN. NOMOR TAHUN 2 0 U TANGGAL MARET 2012 TENTANG P E M E R I N T A H K O T A S I N G K A W A N G Jal«i S U R A T K E P U T U S A N K E P A L A D I N A S P E N D A P A T A N . P E N G E L O L A A N K E U A N G A N K O T A S I N G K A W A N G DAN A S E T N O M O R : T A H U N T E N T A N G P E N U N J U K K A N S E B A G A I W A J I B P U N G U T K E P A L A DI N A S P E N D A P A T A N , P E N G E L O L A A N K E U A N G A N DAN A S E T K O T A S I N G K A W A N G t e n t a n g p a j a k y a n g P a j a k P a j a k Me m b a c a Meni m b a n g Mengl n g a t Mene t a p k a n P E R T A M A - S u r a t K e p u t u s a n Ke p a l a Di n a s P e n d a p a t a n , P e n g e l o l a a n K e u a n g a n d a n A s e t P e n g u k u h a n s e b a g a i W a j i b P a j a k D a e r a h Nomor t a n g g a l 1. b a h w a y a n g b e r s a n g k u t a n t e l a h me m e n u h l p e r s y a r a t a n b a l k s u b j e k ma u p u n o b j e k d a e r a h u n t u k di t u n j u k s e b a g a i w a j i b P u n g u t ; - b b a h w a s e h u b u n g a n d e n g a n h a l t e r s e b u t p e r l u u n t u k m e n e t a p k a n Wajib P a j a k b e r s a n g k u t a n s e b a g a i W a j i b P u n g u t P a j a k R e s t o r a n ; 1. P e r a t u r a n D a e r a h P e m e r i n t a h Kot a S i n g k a w a n g N o m o r 11 T a h u n 2010 t e n t a n g D a e r a h ; 2. P e r a t u r a n Walikota S i n g k a w a n g Nomor : ________________ T a h u n 2012 t e n t a n g P e m u n g u t a n Hotel, P a j a k R e s t o r a n , P a j a k Hiburan, P a j a k Parkir, d a n P a j a k P e n e r a n g a n J a l a n . (berlaku Unknown)
LAMPIRAN
LAMPIRAN
LAMPIRAN

IV

PERATURAN WAUKOTA

SINGKAWANG

: PEMUNGUTAN PAJAK HOTEL PAIAK RESTORAN. PAJAK HIBURAN, PAJAK PARKIR, OAN PAJAK PENERANGAN JALAN.

NOMOR

:

10

TAHUN

2 0 U

TANGGAL

:

22

MARET

2012

TENTANG

IV

## P E M E R I N T A H K O T A S I N G K A W A N G

Jal«i

S U R A T K E P U T U S A N K E P A L A D I N A S P E N D A P A T A N . P E N G E L O L A A N K E U A N G A N K O T A S I N G K A W A N G

DAN

A S E T

N O M O R :

T A H U N

T E N T A N G

P E N U N J U K K A N S E B A G A I W A J I B

P U N G U T

K E P A L A DI N A S P E N D A P A T A N , P E N G E L O L A A N K E U A N G A N DAN A S E T K O T A

S I N G K A W A N G

t e n t a n g p a j a k

y a n g

P a j a k

P a j a k

Me m b a c a

Meni m b a n g

Mengl n g a t

Mene t a p k a n

P E R T A M A

- S u r a t K e p u t u s a n Ke p a l a Di n a s P e n d a p a t a n , P e n g e l o l a a n K e u a n g a n d a n A s e t P e n g u k u h a n s e b a g a i W a j i b P a j a k D a e r a h Nomor t a n g g a l

1. b a h w a y a n g b e r s a n g k u t a n t e l a h me m e n u h l p e r s y a r a t a n b a l k s u b j e k ma u p u n o b j e k d a e r a h u n t u k di t u n j u k s e b a g a i w a j i b P u n g u t ;

- b b a h w a s e h u b u n g a n d e n g a n h a l t e r s e b u t p e r l u u n t u k m e n e t a p k a n Wajib P a j a k b e r s a n g k u t a n s e b a g a i W a j i b P u n g u t P a j a k R e s t o r a n ;

1. P e r a t u r a n D a e r a h P e m e r i n t a h Kot a S i n g k a w a n g N o m o r 11 T a h u n 2010 t e n t a n g D a e r a h ;

2. P e r a t u r a n Walikota S i n g k a w a n g Nomor : ________________ T a h u n 2012 t e n t a n g P e m u n g u t a n Hotel, P a j a k R e s t o r a n , P a j a k Hiburan, P a j a k Parkir, d a n P a j a k P e n e r a n g a n J a l a n .

## MEMUTUSKAN

- S U R A T KEPUTUSAN KEPALA DINAS PENDAPATAN, PENGELOLAAN KEUANGAN A S E T KOTA SINGKAWANG TENTANG PENUNJUKKAN SEBAGAI WAJIB PUNGUT.

MenunjuK

N a m a / B a d a n U s a h a A l a m a t U s a h a

Nomor P o k o k Wajib P a j a k D a e r a h ( N P W P D )

N a m a P e n a n g g u n g P a j a k D a e r a h A l a m a t U s a h a

: •

I

I

I

I

I

I

I

I

m

m

K E D U A

K E T I G A

K E E M P A T

S E B A G A I WAJI B P U N G U T P A J A K Y A N G B E R K E W A J I B A N MENGHITUNG S E N D I R I ( M P S ) A T A U M E M I L I K I P E M B U K U A N A T A U K A S R E G I S T E R

- Me l a k s a n a k a n P e n y e t o r a n a t a s Hasll P e m u n g u t a n P a j a k p a d a s e t i a p t a n g g a l 7 b u l a n b e r i k u t n y a u n t u k J e n i s P a j a k S e l f A s s e s m e n t a t a u s e b e l u m t a n g g a l J a t u h T e m p o u n t u k Official A s s e s m e n L k e c u a l i t a n g g a l t e r s e b u t j a t u h p a d a hari l l b u r .

- S u r a t K e p u t u s a n i n i m u l a l b e r l a k u s e j a k t a n g g a l

- Apabil a d l k e m u d l a n hari t e r d a p a t k e k e l i r u a n d a l a m K e p u t u s a n Ini a k a n d i a d a k a n p e m b e t u l a n s e p e r i i m y a ;

D I T E T A P K A N P A D A T A N G G A L

DI

S I N G K A W A N G

K E P A L A D I N A S P E N D A P A T A N P E N G E L O L A A N K E U A N G A N D A N K O T A S I N G K A W A N G

A S E T

P a n g k a t

NIP

WALIKOTA

S I N G K A W A N G

t t d

HASAN KARMAN

S a l i n a n S e s u a i d e n g a n Asl i n y a

K e p a l a B a g i a n Hutsiim d a n P e r u n d a n g - u n d a n g a n

P e m b i n a

NIP. 19681016 1998 03 1 004

YASMALKAR SH


DAN

P A J A K

P E R A T U R A N W A U K O T A S I N G K A W A N G

L A M P I R A N

N O M O R

T A N G G A L

10

T A H U N 2012

22 MARET 2012

T E N T A N G

P E M U N G U T A N P A J A K HOTEL. PAJAK R E S T O R A N , P HIBURAN. P A J A K P A R K I R . OAN P A J A K P E N E R A N G J A L A N .


N a m a B a d a n U s a h a

A l a m a t

N a m a P e m i l i k

A l a m a t

N P W P D

P E M E R I N T A H K O T A S I N G K A W A N G

J a l a n

T e l p . (0562)

## K A R T U ] \ P W P D

No R e g i s t e r :

S i n g k a w a n g

A n . Walikota S i n g k a w a n g

K e p a l a S a t u a n Kerja P e r a n g k a t D a e r a h

P a n g k a t

NIP.

## PERHATIAN

1. Kartu Ini h a r a p d i s i m p a n b a l k - b a l k d a n a p a b i l a hi i a n g a g a r s e g e r a meiaporkannya k e p a d a P e n d a p a t a n , P e n g e i o i a a n K e u a n g a n d a n As e t Kota S i n g k a w a n g .

Di n a s

2. Kartu ini h e n d a k n y a d i b a w a a p a b i i a S a u d a r a a k a n m e l a k u k a n t r a n s a k s l p e r p a j a k a n

d a e r a h ;

3. Dalam h a l W a j i b P a j a k p i n d a h domisiii, a g a r m e i a p o r k a n diri k e Dinas P e n d a p a t a n , P e n g e l o l a a n K e u a n g a n d a n A s e t K o t a S i n g k a w a n g .

WALIKOTA S I N G K A W A N G t t d H A S A N K A R M A N

S a l i n a n S e s u a i d e n g a n As l i n y a kepa^a^^^^^^^^^^^^u^^)^unAangan


P e m b i n a

NIP. 19681016 1998 03 1 004

*

VI

P E R A T U R A N W A U K O T A S I N G K A W A N G

R E S T O R A N ,

P A J A K

N O M O R

T A N G G A L

T E N T A N G

1 0

T A H U N

2 0 1 2

2 2

MARET

2 0 1 2

P E M U N G U T A N P A I A K HOTEL, P A J A K P A J A K HIBURAN. P A I A K P A R K I R , OAN P E N E R A N G A N J A L A N .

A. S P t P O H O T E L


## P E M E R I N T A H K O T A S I N G K A W A N G

J a l a n

Tel p / F a x .

No S P T P D

Ma s a P a j a k

T a h u n P a j a k

« P T P D

## t S U H A T P E M M E R I T A H U A A - P A J A K U A E R A H I P A J A K H O T E L

N a m a Waj i b P a j a k

A l a m a t

N P W P D

K e p a d a Yth.

•

I

I

I

I

I

I

I

I

m

m

di

P E R H A T I A N

:

1. H a r a p d i i s i d a l a m r a n g k a p 2 ( d u a ) d i t u l l s d e n g a n h u r u p C E T A K

2. Beri N o m o r p a d a k o t a k [ ] y a n g t e r s e d i a u n t u k j a w a b a n y a n g d i b e r i k a n

3. S e t e l a h di i s i d a n d i t a n d a t a n g a n i , h a r a p d i s e r a h k a n k e m b a l i k e p a d a Di n a s P e n d a p a t a n , P e n g e l o l a a n K e u a n g a n A s e t Kot a S i n g k a w a n g p a l i n g l a m b a t t a n g g a l 7 ( t u j u h ) b u l a n b e r i k u t n y a d a n d i g u n a k a n s e b a g a i me d i a me l a k u k a n p e n y e t o r a n

4. Ke t e r l a m b a t a n p e n y e r a h a n d a r i t a n g g a l t e r s e b u t di a t a s a k a n d i l a k u k a n P e n e t a p a n S e c a r a J a b a t a n u n t u k P a j a k y a n g b e t d a s a i k a n Official Assesment d a n D e n d a Self Assesment.

## A. Dl l s l O l e h P e t i f l u e a h a Hot e l

1. Go l o n g a n Hotel

0 1 . B i n t a n g T i g a

02.

03.

B i n t a n g E m p a t

Melati T i g a

04.

Melati D u a

05

E k o n o m i

06.

L a i n n y a

2. Dat a Objek P a j a k H o t e l ( L a m p i r k a n Bill / N o t a P e n j u a l a n

)

No

Gol o n g a n

K a m a r

Tarif

( R p )

J u m l a h

P e r h i t u n g a n Omzat

K a m a r

T a m u /

B u l a n

1

2

3

4

5

6

7

8

9

10

11

12

13

14

J u m l a h

3. Me n g g u n a k a n K a s R e g i s t e r

• 1. Y a 1.

• 2. T k J a k 2.

4. Me n g a d a k a n p e m b u k u a n / p e n c a t a t a n

Q

1.

Y a

Q

2. 2

T i d a k

5. J u m l a h P e m b a y a r a n P a j a k T e r u t a n g u n t u k M a s a P a j a k S e k a r a n g ( l a m p i r k a n fotocopy

d o k u m e n ) :

- a . M a s a P a j a k

- 

T g l

aid

- b. D a s a r P e n g e n a a n ( J u m l a h p e m b a y a r a n y a n g d i t e r i m a

R p

- c . Tarif P a j a k ( s e s u a i P e r d a )

8 %

- d. P a j a k T e r h u t a n g ( b x

c )

R p

d a n u n t u k

Wajib a t a s

## B . P e m y a t a a n

D e n g a n menyadari s e p e n u h n y a a k a n s e g a l a a k i b a t t e r m a s u k s a n k s i - s a n k s l s e s u a i d e n g a n k e t e n t u a n p e r u n d a n g - u n d a n g a n y a n g b e i i a k u , s a y a a t a u s a y a beri k u a s a m e n y a t a k a n b a h w a a p a y a n g t e l a h k a m i b e r i t a h u k a n t e r s e b u t di b e s e r t a l a m p i r a n - l a m p i r a n n y a a d a l a h b e n a r , l e n g k a p d a n j e l a s .

S i n g k a w a n g

Wajib P a j a k

N a m a J e l a s

## C. Di i s i Ol e h D i n a s P e n d a p a t a n P e n g e l o l a a n K e u a n g a n d a n

A s e t

T a t a C a r a p e n g h i t u n g a n d a n p e n e t a p a n y a n g d i k e h e n d a k i :

I I 1 . S e l f A s s e s m e n t ( m e n g h i t u n g d a n m e n e t a p k a n p a j a k s e n d i r i )

2. Officiai A s s e s m e n t ( d i h i t u n g d a n d i t e t a p k a n o l e h P e j a b a t Di n a s P e n d a p a t a n P e n g e l o l a a n K e u a n g a n d a n A s e t

Dit e r i m a t a n g g a l

:

N a m a P e t u g a s

NI P

T a n d a T a n g a n


## P E M E R I N T A H K O T A S I N G K A W A N G

No S P T P D

M a s a P a j a k

T a h u n P a j a k

S P T P D

## &lt; S I I I I A T P E M B E M T A H I I A M P A J A K D A E R A H ) P A J A K R E S T T D n A l S

N a m a W a j i b P a j a k

A l a m a t

N P W P D

K e p a d a Yth.

•

I

I

I

I

I

I I I

m

m

## P E R H A T I A N

1. Harap diisi d a l a m r a n g k a p 2 ( d u a ) di t u l i s d e n g a n h u r u p C E T A K

2. B e r i N o m o r p a d a k o t a k [ ] y a n g t e r s e d i a u n t u k j a w a b a n y a n g d i b e r i k a n

3. S e t e l a h dii s i d a n d i t a n d a t a n g a n i , h a r a p d i s e r a h k a n k e m b a l i k e p a d a D i n a s P e n d a p a t a n , P e n g e l o l a a n K e u a n g a n A s e t Kot a S i n g k a w a n g p a l i n g l a m b a t t a n g g a l 7 ( t u j u h ) b u l a n b e r i k u t n y a d a n d i g u n a k a n s e b a g a i me d i a m e l a k u k a n p e n y e t o r a n

4. Ke t e r l a m b a t a n p e n y e r a h a n dari t a n g g a l t e r s e b u t di a a t a s a k a n d i l a k u k a n P e n e t a p a n S e c a r a J a b a t a n u n t u k P a j a k y a n g t &gt; e r d a s a r f c a n Official Assesment d a n D e n d a u n t u k Self Assesment.

## A. Dl l s l O l e h P e n g u s a h a R e s t o r a n

1. G o l o n g a n R e s t o r a n

| |

|

0 1 .

R u m a h M a k a n

02.

R u m a h Mi n u m

03

C a f e

04

2. Dat a Objek P a j a k R e s t o r a n ( L a m p i r k a n Bill / N o t a P e n j u a l a n )

No

Mej a Y a n g

Tei S M l i a

J u m a h

Kurai

J u m l a h

P e r h i t u n g a n Omzat

P a r h a r i

T a m u

P e r

B u l a n

1

2

3

4

5

J u m l a h

3. Me n g g u n a k a n k a s r e g i s t e r

1

Y a

2. T i d a k

4. Me n g g a d a k a n P e m b u k u a n / P e n c a t a t a n

1. 1

Y a

2. T i d a k

5. J u m l a h P e m b a y a r a n P a j a k T e r u t a n g u n t u k M a s a P a j a k S e k a r a n g ( l a m p i r k a n f b t o c o p y

d o k u m e n ) :

- a . M a s a P a j a k

:

T g l

s / d T g l

- b. D a s a r P e n g e n a a n ( J u m l a h p e m b a y a r a n y a n g di t e r i m a )

R p

- c. Tarif P a j a k ( s e s u a i P e r d a )

:

8 %

- d . P a j a k T e r h u t a n g ( b X c )

:

R p

## B. P e m y a t a a n

D e n g a n menyadari s e p e n u h n y a a k a n s e g a l a a k i b a t t e r m a s u k s a n k s i - s a n k s l s e s u a i d e n g a n k e t e n t u a n p e r u n d a n g - u n d a n g a n y a n g b e r l a k u , s a y a a t a u s a y a beri k u a s a m e n y a t a k a n b a h w a a p a y a n g t e l a h b e r i t a h u k a n t e r s e b u t di a t a s b e s e r t a l a m p i r a n - i a m p i r a n n y a a d a i a h b e n a r , i e n g k a p d a n j e i a s .

k a m i

S i n g k a w a n g

Wajib P a j a k

N a m a J e l a s

Jalan

TelplFax

Rp

d a n u n t u k

Wajib

•

## C. DHsl O l e h D i n a s P e n d a p a t a n P e n g e l o l a a n K e u a n g a n d a n

A s e t

T a t a C a r a p e n g h i t u n g a n d a n p e n e t a p a n y a n g d i k e h e n d a k i :

I I

1. S e l f A s s e s m e n t ( m e n g h i t u n g d a n m e n e t a p k a n p a j a k s e n d i r i )

2. Official A s s e s m e n t ( d i h i t u n g d a n d i t e t a p k a n o l e h P e j a b a t Di n a s P e n d a p a t a n P e n g e l o l a a n K e u a n g a n d a n A s e t

Diterima t a n g g a l

N a m a P e t u g a s

NI P

T a n d a T a n g a n


## P E M E R I N T A H K O T A S I N G K A W A N G

J a l a n

Tel(rfFax.

No S P T P D

M a s a P a j a k

T a h u n P a j a k

S P T P D

## ( S U R A T P E M H E R I T A R I I A N P A J A K D A E R A R ) P A J A K H I B I J R A i S

N a m a Waj i b P a j a k

A l a m a t

N P W P D

K e p a d a Yth.

•

I I I

m

m

Di

-

S l n f l k y w a n f l

## P E R H A T I A N

1. Har a p dii s i d a l a m r a n g k a p 2 ( d u a ) di t u l i s d e n g a n h u m p C E T A K

- 2 Beri N o m o r p a d a

- k o t a k [ ] y a n g t e r s e d i a u n t u k j a w a b a n y a n g d i b e r i k a n

3. S e t e l a h di i s i d a n d i t a n d a t a n g a n i , h a r a p d i s e r a h k a n k e m b a l i k e p a d a Di n a s P e n d a p a t a n P e n g e l o l a a n K e u a n g a n d a n A s e t S i n g k a w a n g p a l i n g l a m b a t t a n g g a l 7 ( t u j u h ) b u l a n b e r i k u t n y a d a n d i g u n a k a n s e b a g a i m e d i a u n t u k m e l a k u k a n p e n y e t o r a n .

4. Ke t e r l a m b a t a n p e n y e r a h a n d a r i t a n g g a l t e r s e b u t di a t a s a k a n d i l a k u k a n P e n e t a p a n S e c a r a J a b a t a n u n t u k Wajib y a n g b e r d a s a r k a n Official Assesment d a n D e n d a Self Assesment.

P a j a k

- 1 . Hiburan y a n g d i s e l e n g g a r a k a n

## A. Dl l s l Ol e h P e n g u s a h a H i b u r a n

0 1 . P e r t u n j u k a n F i l m

02. P e r t u n j u k a n k e s e n i a n d a n o l a h r a g a

03. P a g e l a r a n mus i k d a n t a r i

04. Dis k o t i k

05. K a r a o k e

06. Kl a b Mal a m

07. P e r m a i n a n Bill y a r d

08. P e r m a i n a n K e t a n g k a s a n

09. P a n t i Pi j a t / M a n d i U a p

10. P e r t a n d i n g a n Ol a h r a g a

11

2. Harga T a n d a Ma s u k y a n g b e r l a k u ( s e r t a k a n b o n g g o l

Karcis)

(Khusus untuk pertunjukan film, kesenian, pagelaran musik/tari, ketangkasan dan pertandingan olahraga sejenisnya)

dan

No

Kat e s

Tarif

J u m l a h

P a i t u n j u k k a n

P e r i i K u n g a n

Omzat

B i a s a

U b u r

1

2

3

4

5

J u m l a h

3. J u m l a h Meja / M e s i n

(Khusus untuk Billyard dan Ketan^asan lainnya)

4. J u m l a h K a m a r / R u a n g a n

(Khusus untuk Panti Pijat, Mandi Uap dan Karaoke)

b u a h

b u a h

5. A p a k a h P e n g u s a h a me n y e d i a k a n k a r c i s b e b a s ( f r e e ) k e p a d a o r a n g - o r a n g t e r t e n t u :

2. T k J a k

J i k a YA, b e r a p a j u m l a h y a n g b e r e d a r

b u a h

Kot a

6. Mel a k u k a n P e m b u k u a n / P e n c a t a t a n

• 1. Y a

2. T i d a k

7. J u m l a h P e m b a y a r a n d a n P a j a k T e r u t a n g u n t u k M a s a P a j a k S e k a r a n g

- a . M a s a P a j a k

- b. D a s a r P e n g e n a a n ( J u m l a h p e m b a y a r a n y a n g d i t e r i m a )

- c . Tarif P a j a k ( s e s u a i P e r d a )

- d. P a j a k T e r h u t a n g ( b X

c )

T g l .

R p .

R p .

s / d T g l .

## B. Pemyataan

D e n g a n menyadari s e p e n u h n y a a k a n s e g a l a akit&gt;at t e r m a s u k s a n k s i - s a n k s l s e s u a i d e n g a n k e t e n t u a n p e r u n d a n g - u n d a n g a n y a n g b e r l a k u , s a y a a t a u s a y a t &gt; e r i k u a s a m e n y a t a k a n t &gt; a h w a a p a y a n g t e l a h k a m i b e r i t a h u k a n t e r s e b u t d i a t a s t t e s e r t a l a m p i r a n - l a m p i r a n n y a a d a l a h b e n a r , l e n g k a p d a n j e l a s .

S i n g k a w a n g , .

Wajib P a j a k

N a m a J e l a s

## C. Dl l s l Ol e h P e t u g a s D i n a s P e n d a p a t a n P e n g e l o l a a n K e u a n g a n d a n

A s e t

T a t a C a r a p e n g h i t u n g a n d a n p e n e t a p a n y a n g d i k e h e n d a k i :

I I 1. S e / f A s s e s m e n t ( m e n g h i t u n g d a n m e n e t a p k a n p a j a k s e n d i r i )

2. Official Assesrmnt ( d i h i t u n g d a n d i t e t a p k a n o l e h P e j a b a t D i n a s P e n d a p a t a n P e n g e l o l a a n K e u a n g a n d a n

A s e t

Dit e r i m a t a n g g a l

N a m a P e t u g a s

N I P

T a n d a T a n g a n

%


## P E M E R I N T A H K O T A S I N G K A W A N G

J a l a n

Tel p / F a x .

No S P T P D

M a s a P a j a k

T a h u n P a j a k

S P T P D

## ( S U R A T P E M R E R I T A R U A N P A J A K D A E R A R ) P A J A K P . U I K I H

N a m a Waj i b P a j a k

A l a m a t

N P W P D

K e p a d a Yth.

•

I 1 I I I I I I

m m

P E R H A T I A N

1. Har a p diisi d a l a m r a n g k a p 2 ( d u a ) di t u l i s d e n g a n h u r u p C E T A K

2. Beri N o m o r p a d a k o t a k [ ] y a n g t e r s e d i a u n t u k j a w a b a n y a n g di l i e r i k a n .

3. S e t e l a h dii s i d a n d i t a n d a t a n g a n i , h a r a p d i s e r a h k a n k e m b a l i k e p a d a D i n a s P e n d a p a t a n P e n g e l o l a a n K e u a n g a n A s e t Kot a S i n g k a w a n g p a l i n g l a m b a t t a n g g a l 7 b u l a n b e r i k u t n y a d a n d i g u n a k a n s e b a g a i me d i a u n t u k p e n y e t o r a n .

4. Ke t e r l a m b a t a n p e n y e r a h a n dari t a n g g a l t e r s e b u t di a a t a s a k a n d i l a k u k a n P e n e t a p a n S e c a r a J a b a t a n u n t u k P a j a k y a n g b e r d a s a r k a n Official Assesment d a n D e n d a u n t u k Self Assesment.

## A. Dl l s l Ol e h P e n g e l o l a P a r k i r

1. F a s l l i t a s P a r k i r y a n g d i s e d i a k a n

Q

- 0 1 . K e n d a r a a n R o d a 01

E m p a t

02. K e n d a r a a n R o d a D u a

03. K e n d a r a a n R o d a E m p a t / R o d a

Dua

04. K e n d a r a a n L a i n n y a

2. J u m l a h K e n d a r a a n d a n Tarif P a r k i r

No

J e n i s

Ke n d a r a a n

J u m l a h

Ke n d a r a a n

y a n g

Parkir

Tarif Parkir

( R p )

P e r h i t u n g a n

Omzet

Ngi n a p

B i a s a

Ngi n a p

B i a s a

J u m l a h

3. A p a k a h P e n g u s a h a me n y e d i a k a n k a r c i s b e b a s ( f r e e ) k e p a d a o r a n g - o r a n g t e r t e n t u :

• 1. Y a

2. T i d a k

J i k a YA.

b e r a p a

j u m l a h

y a n g

b e r e d a r

b u a h

4.

Mel a k u k a n

P e m b u k u a n

/ P e n c a t a t a n

•

1.

Y a

2. T i d a k

5. J u m l a h P e m b a y a r a n d a n P a j a k T e r u t a n g u n t u k M a s a P a j a S e k a r a n g :

- a . M a s a P a j a k

:

T g l

s / d T g l

- b. D a s a r P e n g e n a a n ( J u m l a h p e m b a y a r a n y a n g d i t e r i m a

R p

- c. Tarif P a j a k ( s e s u a i P e r d a )

2 0 %

- d. P a j a k T e r h u t a n g ( b X c )

:

R p

di

buah

1

Rp

d a n me l a k u k a n

Wajib

A s e t

## B . P e m y a t a a n

D e n g a n menyadari s e p e n u h n y a a k a n s e g a l a a k i t i a t t e r m a s u k s a n k s l - s a n k s i s e s u a i d e n g a n k e t e n t u a n p e r u n d a n g - u n d a n g a n y a n g t &gt; e r 1 a k u , s a y a a t a u s a y a t&gt;eri k u a s a m e n y a t a k a n t &gt; a h w a a p a y a n g t e l a h k a m i t i e r i t a h u k a n t e r s e b u t d i a t a s b e s e r t a l a m p i r a n - l a m p i r a n n y a a d a l a h b e n a r , l e n g k a p d a n j e l a s .

S i n g k a w a n g

Wajib P a j a k

N a m a J e l a s

## C. Di i s i O l e h P e t u g a s D i n a s P e n d a p a t a n P e n g e l o l a a n K e u a n g a n d a n

A s e t

T a t a C a r a p e n g h i t u n g a n d a n p e n e t a p a n y a n g d i k e h e n d a k i :

- I I 1 . S e / f A s s e s m e n t ( m e n g h i t u n g d a n m e n e t a p k a n p a j a k s e n d i r i )

2. Official Assesment ( d i h i t u n g d a n d i t e t a p k a n o l e h P e j a b a t Di n a s P e n d a p a t a n P e n g e l o l a a n K e u a n g a n d a n

Dit e r i m a t a n g g a l

N a m a P e t u g a s

NI P

T a n d a T a n g a n

J A L A N


## P E M E R I N T A H K O T A S I N G K A W A N G

J a l a n

Tei p / F a x .

No S P T P D

M a s a P a j a k

T a h u n P a j a k

## S P T P D

## ( S D R A T P E M B E R I T A D I I A I V P A J A K D A E R A H ) P A J A K P E I V E R A I V C A I V J A L A N

N a m a Waj i b P a j a k

A l a m a t

N P W P D

K e p a d a Yth.

• I I I I I I I I

m m *

P E R H A T I A N

1. Har a p dl i s i d a l a m rangkap 2 ( d u a ) di t u l i s d e n g a n h u m p C E T A K

2. Beri N o m o r p a d a k o t a k [ ] y a n g t e r s e d i a u n t u k j a w a b a n y a n g d i b e r i k a n

3. S e t e l a h di i s i d a n d i t a n d a t a n g a n i , h a r a p d i s e r a h k a n kemt&gt;ati k e p a d a D i n a s P e n d a p a t a n , P e n g e l o l a a n K e u a n g a n A s e t Kot a S i n g k a w a n g p a l i n g l a m t &gt; a t t a n g g a l 7 ( t u j u h ) b u l a n b e r i k u t n y a d a n d i g u n a k a n s e b a g a i me d i a me l a k u k a n p e n y e t o r a n

4. Ke t e r l a m b a t a n p e n y e r a h a n dari t a n g g a l t e r s e b u t di a a t a s a k a n d i l a k u k a n P e n e t a p a n S e c a r a J a b a t a n u n t u k P a j a k y a n g b e r d a s a r k a n Official Assesment d a n D e n d a u n t u k Self Assesment.

## A . Dll e l Ol e h W a j i b P R j a k

1. A s a l T e n a g a Listrik

[

1

0 1 .

P L N

02.

N o n P L N

2. Gol o n g a n Tarif

[ ]

01.

I n d u s t r i B i s n i s

02.

R u m a h T a n g g a

03.

S o s i a l

04.

3. V o l t a s e

[ 1

0 1 .

110 V o l t

02.

220 V o l t

03.

4. D a y a Listrik

[ 1

0 1 .

450

Watt

02.

900

Watt

03.

1.200

Watt

04.

1.600

Watt

05.

2.200

Watt

06.

&gt; 2.200

Watt

5. Tarif listrik p e r K W H

R p .

6. P e n g g u n a a n l i s t r i k / t a k s i r a n p e n g g u n a a n l i s t r i k B u l a n .

J u m l a h K W H T e r p a k a i :

7. J u m l a h P e m b a y a r a n d a n P a j a k T e r u t a n g u n t u k M a s a P a j a S e k a r a n g :

- a . M a s a P a j a k

- b. D a s a r P e n g e n a a n ( J u m l a h p e m b a y a r a n y a n g d i t e r i m a

- c . Tarif P a j a k ( s e s u a i P e r d a )

- d. P a j a k T e r h u t a n g ( b X c )

T g l . . . .

R p . . . .

5 %

R p .

s / d T g l .

## 8 . P e m y a t a a n

D e n g a n menyadari s e p e n u h n y a a k a n s e g a l a a k i t r a t t e r m a s u k s a n k s l - s a n k s i s e s u a i d e n g a n k e t e n t u a n p e m n d a n g - u n d a n g a n y a n g b e r l a k u , s a y a a t a u s a y a beri k u a s a m e n y a t a k a n b a h w a a p a y a n g t e l a h k a m i b e r i t a h u k a n t e r s e b u t a t a s b e s e r t a l a m p i r a n - l a m p i r a n n y a a d a l a h b e n a r , l e n g k a p d a n j e l a s .

S i n g k a w a n g ,

Wajib P a j a k

N a m a J e i a s

d a n u n t u k

Wajib di


## C. Dl l s l Ol e h P e t u g a s D i n a s P e n d a p a t a n P e n g e l o l a a n K e u a n g a n d a n

A s e t

T a t a C a r a p e n g h i t u n g a n d a n p e n e t a p a n y a n g d i k e h e n d a k i :

I

I

1. S e l f A s s e s m e n t ( m e n g h i t u n g d a n m e n e t a p k a n p a j a k s e n d i r i )

2. Official A s s e s m e n t ( d i h i t u n g d a n d i t e t a p k a n o l e h P e j a b a t Di n a s P e n d a p a U n P e n g e l o l a a n K e u a n g a n d a n A s e t

Diterima t a n g g a l

N a m a P e t u g a s

NI P

T a n d a T a n g a n

WAUKOTA S I N G K A W A N G t t d H A S A N K A R M A N

S a l i n a n S e s u a i d e n g a n As l i n y a

K e p a l a B a g i a n H u k u m d a n P e r u n d a n g - u n d a n g a n

P e m b i n a

NIP. 196810161998 03 1 004

YASMALIZAR SH

P A J A

L A M P I R A N :

V I I

P E R A T U R A N W A L I K O T A S I N G

k m . . .

.

N O M O R

1 0

T A H U N

2 0 1 2

T A N G G A L

2 2

M A R E T

2 0 1 2

T E N T A N G

P E M U N G U T A N P A J A K H O T E L P A J A K R E S T O R A N , H I B U R A N , P A J A K P A R K I R , D A N P A J A K P E N E R A N G A N J J U A N .

## DAFTAR S P T P D

Y A N G D I K I R I M / K E M B A U / B E L U M D I K E M B A U K A N

| | | A L A M A T | T A N G G A L | T A N G G A L | N O |
|-----------------------|---------|---------------|-----------------|-----------------|-------|
| N O M O R F O R M U L | N A M A | | K I R I M | K E M B A U | |

Me n g e t a h u i :

S i n g k a w a n g

Kepal a B i d a n g ( y a n g m e m b i d a n g i )

N I P .

Kepal a Seksi [ y a n g membidangi)

N I P .

| | l a n g g a | i n o m o r | K o d e | SPTPD | | J u ml a h Omxet P a j a k | | | | J e n i s P a j a k T e r u t a n g | | | | |
|----|---------------|---------------|-----------------|---------|---------------|------------------------------|--------------|-------|-------------|-------------------------------------------|---------|--------------|----------|------|
| No | T e r ima | Urut | R e k e n i n g | | T h n Pa| a k | Hotel | Hi b u r a n | MBI B | P a r k i r | l 4 A t * l n e s r a r a n n i o u r a n | M D L O | B- - 1 , 1 - | SB.Walci | S iM |
| | | | | | | | | | | n o i B i | | | | |

Mengetahui Kepala B i d a n g ( y a n g membidangi)

NIP.

S a l i n a n S e s u a i d e n g a n

K e p a l a B a g i a n H u k u m d a n

Asl i n y a P e r u n d a n g - u n d a n g a n


P e m b i n a

NIP. 19681016 1998 03 1 004

S i n g k a w a n g ,

200,

Kepala Seksi ( y a n g membidangi)

NIP.

WALIKJOTA S I N G K A W A N G ttd H A S A N K A R M A N

I

VIII

P E R A T U R A N W A U K O T A S I N G K A W A N G

P A J A K

N O M O R

T A N G G A L

T E N T A N G

1 0

T A H U N 2 0 1 2

2 2 MARET 2 0 1 2

P E M U N G U T A N P A J A K HOTEL, PAJAK R E S T O R A N , HIBURAN, P A J A K P A R K I R , OAN P A J A K P E N E R A N G A N J A L A N .

## A. KARTU DATA PAJAK

HOTEL

## KARTU DATA PAJAK HOTEL

T a h u n P a j a k

N P W P D

•

1. N a m a B a d a n U s a h a

2. A l a m a t

- 3 . N a m a P e m i l i k

4. A l a m a t

- A. Objek P a j a k Hotel

Gol o n g a n Hotel

0 1 .

B i n t a n g Ti g a

02.

B i n t a n g E m p a t

0 3 . M e l a t i T i g a

04. Mel a t i Dua

05

E k o n o m i

06.

Lai n n y a

N o

G o l o n g a n

K a m a r

Tari f

( R p )

J u m l a h

K a m a r

- B. Oiisi U n t u k Objek P a j a k Hotel

1. Me n g g u n a k a n Kas R e g i s t e r

2. Me n g g u n a k a n P e m b u k u a n / P e n c a t a t a n

3. J u m l a h O m s e t d a n s e t o r a n y a n g d i l a k u k a n

I

J

[

]

1.

Ya

1.

Ya

2.

Ti d a k

2.

T i d a k

N o

T a n g g a l

M a s a

O m s e t

( R p )

T a n g g a l

S e t o r

J u m l a h

S e t o r a n

Meng e t a h u i Kepala B i d a n g P e n d a p a t a n

(

NIP.

Di p e r i k s a Kasi P e n d a t a a n P e n e t a p a n

(...

NIP

## KARTU DATA PAJAK RESTORAN

T a h u n P a j a k

NPWPD •

1. N a m a B a d a n U s a h a

2. A l a m a t

3. N a m a P e m i l i k

4. A l a m a t

- A. Objek P a j a k R e s t o r a n

Gol o n g a n R e s t o r a n

- 0 1 .

R u m a h Ma k a n

02.

R u m a h MI n u m

03. Caf e

No

J u m l a h Meja

J u m l a h Kursi

J u m l a h T a m u / H a r i

- B. Diisi Unt u k Objek P a j a k R e s t o r a n

1. Me n g g u n a k a n Kas R e g i s t e r

2. Me n g g u n a k a n P e m b u k u a n / P e n c a t a t a n

3. J u m l a h O m s e t d a n s e t o r a n y a n g d i l a k u k a n

[

1

[ 1 1. Ya

1.

Ya

2. Ti d a k

2. T i d a k

No

Tanggal

Masa

Omset

Tanggal Setor

J u m l a h

S e t o r a n

Meng e t a h u i Kepal a B i d a n g P e n d a p a t a n

Di p e r i k s a Kasi P e n d a t a a n P e n e t a p a n

(

NIP.

(...,

NIP

(Rp)

## KARTU DATA PAJAK HIBURAN

T a h u n P a j a k

NPWPD

11

1. N a m a B a d a n U s a h a

2. A l a m a t

3. N a m a P e m i l i k

4. A l a m a t

1. J e n i s Hi b u r a n

0 1 .

- P e r t u n j u k a n F i l m

06. Klab Ma l a m

02.

P e r t u n j u k a n k e s e n i a n d a n o l a h r a g a

07. P e r m a i n a n Bil l y a r d

03. P a g e l a r a n mus i k d a n t a r i

08. P e r m a i n a n K e t a n g k a s a n

04. Di s k o t i k

09. P a n t ! P i j a t / M a n d i U a p

05. Kar a o k e

10. P e r t a n d i n g a n Ol a h r a g a

11.

2. Tarif, F a s l l i t a s , d a n W a k t u P e r t u n j u k a n

- 2.1. Bi l y a r d d a n P e r m a i n a n K e t a n g k a s a n

- a . J u m l a h Mej a / M e s i n

- b. Tarif p e r m e j a / G a m e

- c. R a t a - r a t a k e g i a t a n / h a r i

b u a h

R p •

j a m

- 2.2. P a n t i Pi j a t , Kar a o k e d a n M a n d i Uap

No

Kelas Kamar

J u m l a h Kamar

Tarif

T a m u / Hari

3. J u m l a h y a n g d i b a y a r d a n s e t o r a n y a n g d i l a k u k a n

No

Tanggal

Masa

J u m l a h

y a n g

di b a y a r

Tanggal Set o r

J u m l a h

S e t o r a n

Meng e t a h u i Kepal a B i d a n g P e n d a p a t a n

Di p e r i k s a Kasi P e n d a t a a n P e n e t a p a n

(

NiP.

(

NIP

## KARTU DATA PAJAK

PARKIR

T a h u n P a j a k

NPWPD

1. N a m a B a d a n U s a h a

2. A l a m a t

3. N a m a P e m i l i k

4. A l a m a t

1. J e n i s K e n d a r a a n

:

- 0 1 . K e n d a r a a n R o d a E m p a t

02. K e n d a r a a n R o d a Dua

03. K e n d a r a a n R o d a E m p a t / R o d a Dua

04. K e n d a r a a n Lai n n y a

No

J e n i s Kendaraan

J u m l a h

Kendaraan

Tarif

3. J u m l a h y a n g d i b a y a r d a n s e t o r a n y a n g d i l a k u k a n

No

Tanggal

Masa

J u m l a h

y a n g

di b a y a r

Tanggal S e t o r

J u m l a h

S e t o r a n

Me n g e t a h u i Kepal a B i d a n g P e n d a p a t a n

Diperiksa Kasi P e n d a t a a n P e n e t a p a n

)

NIP.

NIP


## KARTU DATA PAJAK PENERANGAN JALAN

T a h u n

P a j a k

NPWPD •

I M I I I 1 1

m

•

1. N a m a B a d a n U s a h a

2. A l a m a t

3. N a m a P e m i l i k

- 4 . A l a m a t

1. As a l T e n a g a Listrik

2. Gol o n g a n Tarif

3. V o l u m e

[

]

- 1 . P L N

[

]

- 1 . I n d u s t r i

[

]

1 . n

o

Volt

- 4 . 1 6 0 0 Volt

- 2 . N o n P L N

2. R u m a h T a n g g a

2. 4 5 0 Volt

5. 2 2 0 0 Volt

3. S o s i a l

3. 9 9 0 Volt

6. &gt; 2 2 0 0 Volt

3. P e n g g u n a a n Li s t i i k d a n S e t o r a n y a n g d i l a k u k a n

No

Tanggal

Masa

J u m l a h K w h

y a n g

t e r p a k a i

Tanggal Setor

J u m l a h

S e t o r a n

Me n g e t a h u i Kepal a B i d a n g P e n d a p a t a n

Di p e r i k s a Kasi P e n d a t a a n P e n e t a p a n

(

NIP.

...)

NIP

WALIKOTA S I N G K A W A N G t t d HASAN KARMAN

S a l i n a n S e s u a i d e n g a n Asl i n y a

K e p a l a B a g i a n H u k u m d a n P e r u n d a n g - u n d a n g a n

P e m b i n a

NIP.

1 9 6 8 1 0 1 6 1 9 9 8 0 3 1 0 0 4

L A M P I R A N :

I X

P E R A T U R A N W A L I K O T A S I N G K A W A N G

N O M O R

10

T A H U N

2012

T A N G G A L

22

M A R E T

2012

T E N T A N G

P E M U N G U T A N P A J A K H O T E U P A J A K R E S T O R A N , P A J A K H I B U R A N , P A J A K P A R K I R , OAN P A J A K P E N E R A N G A N J A L A N .

## D A F T A R S U R A T T E G U R A N

U N T U K M E M A S U K K A N S P T P D

'

Halaman :

| NO | S U R A T | S U R A T | N A M A | A U M A T U N G K A P | NPWPO |
|------|---------------|-------------|-----------|-------------------------|---------|
| NO | T A N G G A L | NORROR | | | |

M e n g e t a h u l :

S i n g k a w a n g ,

Kepala Bidang ( y a n g m e m b i d a n g i )

NIP.

S a l l n a n S e s u a i d e n g a n A s l i n y a K e p a l a B a g i a n Hukiur) d a n P e r u n d a n g - u n d a n g a n


NI P . 1 9 6 8 1 0 1 6 1 9 9 8 0 3 1 0 0 4

Kepala Seksi ( y a n g m e m b i d a n g i )

NIP.

WALIKJOTA S I N G K A W A N G t t d H A S A N K A R M A N

L A M P I R A N

S A L I N A N P E R A T U R A N W A U K O T A S I N G K A W A N G

X

N O M O R

T A N G G A L

T E N T A N G

10

T A H U N

2012

22 M A R E T 2012

P E M U N G U T A N P A I A K H O T E L , P A J A K R E S T O R A N , P A J A K H I B U R A N , P A J A K P A R K I R , D A N P A J A K P E N E R A N G A N J A L A N .



## P E M E R I N T A H K O T A S i N G K A W A N G

J a l a n

T e l p / F a x ,

N P W P O :

•

I

I

I

I

I

t

I

I

m

m

K e p a d a Yth.

d i

## S U R A T T E G U R A N

U N T U K M E M A S U K K A N S P T P D

N o m o r :

B e r d a s a r k a n c a t a t a n k a m i , t e m y a t a s a m p a i s a a t i n i S a u d a r a be\um m e m a s u k k a n S P T P D y a n g t e l a t i s a u d a r a t e r i m a u n t u k dii s i .

M a k a d e n g a n i n i k a m i mi n t a a g a r S a u d a r a m e n y e r a h k a n k e m b a l i S P T P D p a l i n g l a m t i a t 7 ( t u j u h ) h a r i s e t e l a h m e n e r i m a S u r a t i n i

A p a b i l a S u r a t T e g u r a n Ini t i d a k j u g a S a u d a r a i n d a h k a n , m a k a k a m i a k a n m e l a k u k a n P e n e t a p a n A t a s O b j e k P a j a k y a n g s a u d a r a miliki s e c a r a j a b a t a n .

U n