Certificate Of Exemption
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1STATE OF OHIO
CUYAHOGA COUNTY
Lodging Occupancy Tax
“Certificate of Exemption”
The undersigned hereby claims exemption from Cuyahoga County Excise Tax on Lodging of Transient Guest
upon rent for lodging and certifies that this claim is based upon one of the following reasons:
The “Rent is Paid Directly by”:
(Check One)
1. Federal Government* -Need copy of ID and type of payment.
_______
a. State of _______________________(Ohio Excluded)*
_______
(Name of State)
b. Political Subdivision* _____________________________
_______
(Name of State and Subdivision)
2. Foreign Missions _______________________________
- Need front and back copy of ID. _______
(Name of Mission)
- Need copy of type of payment.
3. The rent is not subject to tax as a consequence of the Guest(s)
Non-Transient Status. A copy of the folio representing 30 or more
_______
Consecutive days must be attached to this form.
Date of Arrival____________
Date of Departure_____________
4. The rent is not subject to tax as a consequence of the Guest(s)
_______
Contracted-Room Status. A copy of the contract must be attached to this form.
Date of Arrival____________
Date of Departure_____________
The vendor must attach this certificate to a copy of the bill, statement or invoice and copies of any checks, credit card
information, or other form of payment that would support tax-exempt status for this transaction.
__________________________________
___________________________________
Name
Employee Name (Print)
__________________________________
___________________________________
Address
Title
__________________________________
___________________________________
City, State, and Zip
Sign and Date
__________________________________
Phone
*CAUTION: If payment is not a direct bill, be sure that the credit card is one that permits the transactions to
be Tax Exempt; and, not the guests’ personal credit card.
Prescribed by the Cuyahoga County Lodging Bed Tax Department
Revised May 2012
Effective Date: 1/1/2007
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