Transient Occupancy Tax Report Form - City Of Mesa, Arizona Page 2

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TRANSIENT OCCUPANCY TAX REPORT
Code 0530
Make Checks Payable to:
CITY OF MESA
PO Box 1466
Mesa, AZ 85211-1466
PLEASE USE BLACK INK!
Business Name:__________________________________
Reporting Period __________________
Address:________________________________________
License Number __________________
_______________________________________________
Part 1 - Gross Rents
Total amount charged for transient occupancy of space including the use of
furnishings.*
__________________
Part 2 - Calculation of Tax
(1)
3 % of Gross Rents
__________________
(2)
Excess Tax Collected
__________________
(3)
Penalty and Interest **
__________________
Total Due (Add (1), (2), & (3))
__________________
Part 3 - Affirmation
I swear (or affirm) that this return has been examined by me and that to the best of my knowledge and
belief, it is a true and complete return for this period.
___________________________________________________________________________________
Signature of Taxpayer or Authorized Agent
Title
Date
Phone_Number
THIS RETURN MUST BE RECEIVED IN THE OFFICE OF TAX & LICENSING BY THE
LAST WORKING DAY OF THE MONTH FOLLOWING THE PERIOD BEING
REPORTED
.
************************************************************************************
CHANGE OF OWNERSHIP OR TERMINATION: If no longer active in Mesa, explain below:
Date of last activity: ___________________________
Reason:___________________________________________________________________
If sold, to whom:_____________________________________________________________
Address:___________________________________________________________________
* Transient occupancy - The tax is due on occupancy for the first 30 consecutive days.
**Penalty - Failure to file is 5% of tax due, accumulating monthly. Failure to pay is 10% of tax due.
Combined penalties not to exceed 25%. Interest - 1% per month or fraction thereof.
Tax and Licensing
55 North Center Street - P.O. Box 1466 - Mesa, Arizona - 85211-1466 - (480) 644-2316

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