City of Alexandria, Virginia
DEPARTMENT OF FINANCE
REPORT OF TRANSIENT LODGING TAX
(City of Alexandria Code Section 3-2-141 through 3-2-151)
REPORTING PERIOD:
(Month/Year)
Owner Name
Federal I.D. Number ___________________________
Trade Name
Business License Number _______________________
Business Location _____________________________________________________________________________________
____________________________________________________________________________________________________
Gross Receipts
Number of Room Rentals
For the Month
Per Night For the Month
1. Total Gross Rentals
$
____
_______________________
2. Allowable Deductions
A. Exempt Rentals (Over 90 Consecutive Days)
$
____
_____________________
B. Other Exempt Rentals Included in Line 1
$
___
_____________________
C. Exempt Rentals Included in Prior Reports
$
__
_____________________
D. Total Deductions
$
____
_____________________
3. Line 1 Less Line 2D
3A. $
____ 3B. _____________________
4. Tax on Gross Receipts (5.5% of Line 3A)
$_________________________
5. Tax Per Room Per Night (Line 3B x $1)
$_________________________
6. Total Tax Due (Line 4 Plus Line 5)
$_________________________
7. Penalty for Late Payment (10% of Amount on Line 6)
$_________________________
8. Interest (10% Per Annum on Sum of Amounts on Lines 6 and 7)
$ _________________________
9. Total Tax, Penalty and Interest (Sum of Lines 6, 7 & 8)
$ _________________________
10. Other Non-Taxable Sales (Telephone, Valet, etc.)
$_________________________
11. Total Gross Receipts (Line 1 plus Line 10)
$_________________________
____________________________________________________________________________________________________
I declare that this report has been examined by me and to the best of my knowledge and belief is a true, correct and complete
report.
Preparer’s Name_________________________________________ Signature _____________________________________
The report and tax payment are due on or before the last day of the calendar month following the month being reported.
Make check payable to the “City of Alexandria”. Please return this report with payment to:
Business Tax Audit Unit
Department of Finance
City of Alexandria - Miscellaneous Tax
Dept. 939
Alexandria, VA 22334-0939
Telephone: (703) 838-3869