Transient Occupancy Tax Type "A" Exemption Certificate For Governmental Agencies (Page 3 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 “C” EXEMPTION CERTIFICATE

FOR FOREIGN DIPLOMATIC or CONSULAR PERSONNEL & DEPENDENTS

This form is to be completed by a Foreign Diplomat, Consular Service Personnel Member or qualified dependent of such, requesting an

exemption from San Francisco’s Transient Occupancy Tax under Sec. 6.8-1 (4) 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: $

Foreign Diplomat/Consular Name:

(First Name)

(Last Name)

Foreign Diplomat/Consular USA Address:

(Address)

(City)

(State)

(Zip)

Foreign Diplomat/Consular Telephone Number:

(

)

Country Represented:

Driver’s License:

(Country/State)

(Number)

Foreign Agency Headquarters:

(Address)

(City)

(State)

(Zip)

Foreign Agency Telephone Number:

(

)

I hereby declare under penalty of perjury that:

1. I am a Foreign Diplomat, Consular Service Personnel Member or qualified dependent of such.

2. I understand that in order to be exempt from the payment of Transient OccupancyTaxes, I must present a valid

Individual or Mission Tax Exemption Card bearing my name.

3. I understand that no exemption will be granted if I do not submit a copy of a valid Department of State Tax

Exemption Card.

4. 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 meet the requirements for the exemption ( e.g. an Individual or Mission Tax Exemption Card.) 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 Individual or Mission Tax Exemption

Card 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 3

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