Transient Occupancy Tax Type "A" Exemption Certificate For Governmental Agencies (Page 2 of 4) in pdf

ITY AND

OUNTY OF

RANCISCO

& T

- B

FFICE OF THE

REASURER

OLLECTOR

USINESS

ECTION

Street Address: 1 Dr. Carlton B. Goodlett Place, Room 140, San Francisco, CA 94102

Mailing Address: P.O. Box 7425, San Francisco, CA 94120-7425

José Cisneros

Treasurer

TRANSIENT OCCUPANCY TAX

TYPE “B” EXEMPTION CERTIFICATE

FOR EXEMPT CORPORATION OR ORGANIZATION

This form is to be completed by a representative or employee of an exempt corporation or organization requesting an exemption from San

Francisco’s Transient Occupancy Tax under Sec. 506 (b) of the San Francisco Business and Tax Regulations Code. The operator, as

defined under Article 7 Sec. 501 of the Business and Tax Regulations Code, must retain this completed form and supporting documents for

five years.

Name of Operator:

Address:

San Francisco, CA

(Number & Street)

( Zip)

Dates of Occupancy:

Amount

(Check In:)

(Check Out:)

Paid for the Room:

Employee Name:

(First Name)

(Last Name)

Employee Address:

(Address)

(City)

(State)

(Zip)

Employee Telephone #:

Driver’s License:

(

)

(State)

(Number)

Name of Corporation or Organization:

Organization Address:

(Address)

(City)

(State)

(Zip)

Organization Telephone #:

(

)

I hereby declare under penalty of perjury that I am a representative or employee of the exempt corporation or

organization indicated above; and that such charges are incurred in the performance of my official duties as a

representative or employee of such exempt corporation or organization; and that the foregoing facts and statements

are true and correct.

Executed at:

(City)

(State)

Signature:

Date:

NOTE:

In all cases in which the tax is not collected by the operator, the operator shall be liable to the Tax Collector of the

City and County of San Francisco for the tax due on the taxable rent received for the rental as though the tax had

been paid by the occupant.

Operators should not accept this certificate unless the person presenting it submits satisfactory proof that he/she

meets the requirements for the exemption (e.g. organization’s IRS Exemption Letter or Certification.). A separate

exemption certificate is required for each occupant claiming this exemption.

TO BE COMPLETED BY OPERATOR/STAFF

This exemption is not valid unless a copy of the organization's IRS Exemption Letter or

Certification is attached.

Verified by:

___________________________________

_____________________________

_______________________

Print Employee’s Name

Employee’s Signature

Date

TOT Type A Exemption Form

(Previous editions of this form are not valid)

Rev Mar 2014

Transient Occupancy Tax Type "A" Exemption Certificate For Governmental Agencies Page 2

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