Hotel/motel Occupancy Tax Form - Charleston, Wv
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1CITY COLLECTOR’S OFFICE
Phone: (304)348-8024
915 Quarrier Street Suite 4
Fax: (304)348-1810
Charleston, WV 25301
HOTEL/MOTEL OCCUPANCY TAX
Please make checks payable to City Collector and mail to: City Collector’s Office, 915 Quarrier Street
Suite 4; Charleston, WV 25301.
FOR THE MONTH ENDING
I HEREBY CERTIFY THAT THE FIGURES SHOWN ON THIS FORM
DUE DATE
ARE IN ACCORDANCE WITH ORDINANCE NO.
3893 OF THE CITY
OF CHARLESTON, WEST VIRGINIA
OCCUPANCY RECEIPTS $
6% TAX ON ABOVE AMOUNT
Hotel Name _______________________________________
PENALTY
INTEREST
TOTAL REMITTANCE $
SIGNATURE
DATE
RETURN THIS PORTION WITH REMITTANCE
CITY COLLECTOR’S OFFICE
915 Quarrier Street Suite 4
Charleston, WV 25301
HOTEL/MOTEL OCCUPANCY TAX
Please make checks payable to City Collector and mail to: City Collector’s Office, 915 Quarrier Street
Suite 4, Charleston, WV 25301.
FOR THE MONTH ENDING
I HEREBY CERTIFY THAT THE FIGURES SHOWN ON THIS FORM
DUE DATE
ARE IN ACCORDANCE WITH ORDINANCE NO.
3893 OF THE CITY
OF CHARLESTON, WEST VIRGINIA
OCCUPANCY RECEIPTS $
6% TAX ON ABOVE AMOUNT
Hotel Name _______________________________________
PENALTY
INTEREST
TOTAL REMITTANCE $
SIGNATURE
DATE
PLEASE RETAIN THIS COPY FOR YOUR RECORDS
Revised 10/2006
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