PDF County Innkeepers Tax Return
(Revised 5-18)
Federal Tax ID Entity Name Street Location Name
County Name ___________________________
County Innkeepers Tax Return
To be filed with County Treasurer's Office
State Tax ID
Period End Date
City Enter Address if Different From Above
Amended Return
Due on or before the 20th day following the month collected.
County Code
State
ZIP Code
Authorized Signature
_______________________________
I declare under penalties of perjury that this is a true, correct and complete return.
Date: ______________
Phone Number: __________________
Printed Name of Person Signing This Return
_______________________________
Title: ___________________________
Total Receipts from Rental of Accommodations.......................... A._________________
Total Exempt Rentals of Accommodations.................................. B._________________
Net Taxable Receipts (Subtract Line B from Line A)................... C._________________
County Innkeepers Tax Due (Line C X Rate).............................. D._________________ Collection Allowance __0_._7_3_%___ Do Not Use this Line if the Payment is Late................................ E._________________
Net Tax Due (Subtract Line E from Line D)................................. F._________________ Penalty is Greater of $5 or 10% of Line D (Plus Interest) Use this line only if return is filed late.......................................... G._________________
Adjustments - If this is a negative entry, use a negative sign. (you must attach an explanation)................................................ H._________________
Amount Due (Total Lines F and G plus or minus H).................... I. _________________
For annual interest rates see Department of Revenue Departmental Notice #3.
The permissible collection allowance rate is based on your annual tax liability for all locations in county last year.
? If your annual liability did not exceed $60,000 the permissible rate is 0.73%. ? If your annual liability was greater than $60,000 but did not exceed $600,000
the permissible rate is 0.53%. ? If your annual liability was greater than $600,000 the permissible rate is 0.26%.
Important: This form must be filed even though no tax is due. Please file and remit payment to: For Official Use Only
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