Northern Division Head Tax Work Sheet

For competitions subject to Northern Division Head Tax and Northern Division Development Tax, use this sheet to calculate the head tax due on the competition. If the organizer comps competitors with the best race points, they do not pay Northern Division Head Tax on those competitors. They do pay the Northern Division development fund tax. Adjust the " Total Entries" figure and list the compensated competitors on the bottom of this form.

COMPETITION DATE(S): _______________________________________________________

Total Entries

1^st Run DNS

Head Count

Competition 1

Code #

Men

Code #

Women

Competition 2

Code #

Men

Code #

Women

Competition 3

Code #

Men

Code #

Women

Competition 4

Code #

Men

Code #

Women

Competition 5

Code #

Men

Code #

Women

Competition 6

Code #

Men

Code #

Women

Total Head Count:
Number Compensated:

HD Head Tax = $5.00 x Total Head Count (Do not include compensated competitors, list those competitors below)	$_________________________________
ND Development Fund = $2.00 x Total Head Count (Must include any ND compensated competitors)	$_________________________________

Send 1 copy of the start list, results, and this form to Sherri Hale, Northern Division USSA Manager, P.O. Box 217, Whitefish, MT 59937, nodivmanager@northernussa.org, within 3 days following the competition. Checks should be made payable to Northern Division (indicate what each check is for).

List of competitors compensated: ___________________________________________________________________________________________________________

________________________________________________________________________________________________________________________________________