Transient Occupancy Tax Form
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1City of Blue Ash
TAX COMMISSION
4343 COOPER ROAD
BLUE ASH, OH 45242-5699
TELEPHONE (513) 745-8516
TRANSIENT OCCUPANCY TAX
Registration No. ________
NAME _________________________________________________________________________________________
ADDRESS ______________________________________________________________________________________
ESTABLISHMENT:
HOTEL-MOTEL_____
APARTMENT HOTEL_____
LODGING HOUSE_____
OTHER___________________________________________________________
(description of business operation)
If new business or change of ownership, indicate starting date: _________________
REPORTING PERIOD – FROM ______ / _______ / _______ TO ______ / _______ / _______
TOTAL REVENUE FROM ALL ROOM RENTALS:
$___________________
ALLOWABLE DEDUCTIONS:
Occupancy rent paid directly by the Federal
government, State of Ohio or City agencies
$___________________
Other (non-rent items – food, telephone charges, etc.)
$___________________
Upon rents of two dollars ($2.00) a day or less
$___________________
TOTAL ALLOWABLE DEDUCTIONS:
$_______________________
TAXABLE RENT:
$_______________________
COMPUTATION OF TAX
3% of TAXABLE RENT
$_______________________
TAX COLLECTED
$_______________________
AMOUNT REMITTED (larger of AMOUNT DUE or TAX COLLECTED)
$_______________________
Delinquent penalty (10% per month or part thereof until paid)
$____________
Interest (1% per month or part thereof until paid)
$____________
TOTAL TAX, PENALTY AND INTEREST
$_____________________
Under penalties of perjury, I declare that I have examined this return and the records substantiating the above
allowable deductions, and to the best of my knowledge and belief, it is true, correct and complete.
Signed ____________________________________________________
Title _____________________________________________________
Mail to BLUE ASH TAX COMMISSION, 4343 COOPER ROAD, BLUE ASH, OH 45242-5699
Make checks payable to BLUE ASH TAX COMMISSION
APRIL 30
JULY 31
OCTOBER 31
JANUARY 31
1st Quarter Due
2nd Quarter Due
3rd Quarter Due
4th Quarter Due
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