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

Transient Occupancy Tax Type "A" Exemption Certificate For Governmental Agencies Page 4

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 “D” EXEMPTION CERTIFICATE FOR PERMANENT RESIDENT/GUEST

This form is to be completed by: (1) a permanent resident or (2) a guest whose rent is less than $40 a day or $100 a week, who requests

exemption from San Francisco’s Transient Occupancy Tax under Sec. 506 (a) or (c) of the San Francisco Business and Tax Regulations

Code. See Tax Collector Regulation 1.504-2 for more information. 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)

 Permanent Resident for at least 30 consecutive days

Type of Exemption:



Guest whose Rent is less than $40 a day or $100 a week

(check appropriate box)

Dates of Occupancy:

Amount

(Check In:)

(Check Out:)

Paid for the Room: $

Resident/Guest Name:

(First)

(Last)

Resident/Guest Address:

Resident/Guest Telephone #:

Driver’s License:

(State)

(Number)

(

)

Resident/Guest Suite Number:

I hereby declare under penalty of perjury that I am a resident/guest as indicated above 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.

TO BE COMPLETED BY HOTEL OPERATOR/STAFF

This exemption is not valid unless copies of the lease contract/agreement or proof of

payment (non-refunded) for at least 30 days of continuous occupancy are attached.

Verified by:

___________________________________

_____________________________

_______________________

Print Employee’s Name

Employee’s Signature

Date

TOT Type D Exemption Form

(Previous editions of this form are not valid)

Rev Mar 2016

Transient Occupancy Tax Type "A" Exemption Certificate For Governmental Agencies Page 4

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