About city, prefectural tax (for special collection), there was delivery book of blank paper, how should we list?

If you are using a blank delivery form, please fill out the following six fields and use it.
1 Municipal code (If you are unsure, please check here "List of Municipal Codes for Special Collection Delivery (PDF: 89KB) (PDF: 89KB)")
2. Date of delivery
3 Designated Number　※Do not include hyphens in the designated number column of the delivery notice on the far right, and indicate * on C/D. The designated number in the special collection tax amount (change) notice is □□ －In the case of △△△△, it is “□□ △△△△△△△△” *”.
4 Amount delivered　※When paying Retirement income, please do not include the amount in the Retirement income column and the delivery report on the back of the payment notice.
5 Due date
6. Address or location, name or name of the person with special collection obligation

[Example]

If you have any concerns about the entry method, please contact the Yokohama City Finance Bureau Tax Payment Management Section.
Yokohama City Finance Bureau Tax Payment Management Section Special Collection Section Phone: 045-671-3096