Short Term Rental Tax Registration Form - Spotsylvania

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COMMISSIONER OF THE REVENUE
DEBORAH F WILLIAMS
Acct # ________
PO BOX 175
SPOTSYLVANIA, VA 22553
(540) 582-7062 x 685
Short Term Rental Tax Registration Form
________________________________
___________________________________
Owner’s Name
Name of Business
________________________________
___________________________________
Mailing Address
Physical Address (No P O Boxes)
________________________________
___________________________________
City
State
Zip
City
State
Zip
Social Security # _____/____/______
Federal ID # ___/________________
(
)__ __-_____
(
)_ ___-___ __
Owner’s Phone #
Business Phone #
(
)
_____ Individual
_____ Partnership
______ Corporation
_____ Other
TYPE OF OWNERSHIP:
Check one
_____/_____/______
START DATE :
Month
Day
Year
__________________________________________________
TYPE OF PROPERTY OFFERED FOR RENTAL:
(
Please attach a separate list of rental inventory and copies of rental contracts)
PLEASE COMPLETE GROSS RECEIPTS INFORMATION:
Previous Calendar Year Gross Receipts for all rentals
$ _______________________
Previous Calendar Year Gross Receipts for Rentals of 92 consecutive days or less.
$ _______________________
(Equipment rented with an operator should be excluded from gross receipts of 92 days or less.)
I/We, the undersigned, hereby certified under penalty of perjury, that the information provided herein
and above, is true and correct to the best of my/our knowledge and belief.
____________________________
___________________________________________________
Signature/Title
Date
Printed Name
* * * SEPARATE REGISTRATION FORM REQUIRED FOR EACH LOCATION * * *
FOR OFFICIAL USE ONLY
80% ratio in rentals of 92 days or less ___Yes ___ No
___ Approved ___ Denied ___ Deferred
Remittance Forms Mailed ___________
Date ____________________________
Reviewed by ________________

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