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General - Hotel and Motel Tax Form

  1. (All hotel and motel lodging furnished guests)
  2. (Permanent guest, continuous lodging over 30 days)
  3. (Attach exemption certificate) tax
  4. (Add lines 2 and 3)
  5. (Line 1 less line 4)
  6. (Enter 3% of line 5)
  7. (Include an explanation)
  8. (10th per month for late payment)
  9. (Sum of lines 6, 7 & 8)
  10. (Please upload any necessary or required attachments)
  11. Electronic Signature Agreement*
    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date. I hereby certify that the information and statements contained herein and in schedule of exhibition attached are true and correct)
  12. Please note:
    To avoid penalty and interest, payments must be received on or before the 15th of the month following the taxing period.
  13. Ownership / Name Change
    Notify the Treasurer or any change in ownership or name change.
  14. Leave This Blank:

  15. This field is not part of the form submission.