Exhibit "E" - Lodging Occupancy Tax Return Form
Download a blank fillable Exhibit "E" - Lodging Occupancy Tax Return Form in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Exhibit "E" - Lodging Occupancy Tax Return Form with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2Print
Reset Form
EXHIBIT “E”
TAXES FOR THE MONTH OF
TAXES DUE BY
___________/20____
__________/21/20__
CUYAHOGA COUNTY
LODGING OCCUPANCY TAX RETURN
PARCEL NUMBER
TAX DISTRICT\MUNICIPALITY
***
------------------->* _ _ _ - _ _ - _ _ _
010\Cleveland – 010
NAME AND ADDRESS OF WHERE TO BE MAILED TO
HOTEL/MOTEL NAME AND ADDRESS
Name of Hotel ______________________
Name of Hotel ______________________
Address ___________________________
Corporate Name _______________________
City ________________, State ______ Zip ______
Address ___________________________
City _____________, State ______ Zip _____
Attn: Contact Person: ____________________
IF THE HOTEL HAS CHANGED OWNERSHIP OR CHANGED NAMES, PLEASE INDICATE
DATE_______ OF CHANGE, NAME _________________________________________________________
OF THE NEW OWNERS.
0.00
1. GROSS ROOM REVENUE FOR THE MONTH ………………………………
$ _______________
0.00
2. ADJUSTMENTS OR ALLOWANCES TO REVENUE …………………….…
$ _______________
0.00
3. EXEMPTED ROOM REVENUE (SEE CODE OF REGULATIONS) …..……
$ _______________
Attach Hotel/Motel Exemption Report. See Exhibit C
0.00
4. NET TAXABLE ROOM REVENUE (LINES 1 AND 2 LESS 3) ………….…
$ _______________
0.00
5. TAX REVENUE DUE (ENTER 0.055 OF LINE 4) …………………….….…… $ _______________
6. TOTAL PAYMENT ENCLOSED …………………………………………….… $ _______________
I KNOWINGLY AFFIRM AND DECLARE UNDER THE PENALTY OF PERJURY {ORC 2921.13(A)(7)}
THAT I HAVE EXAMINED THIS FORM, AND THAT THE RECORDS HEREIN ARE TRUE, CORRECT AND
COMPLETE TO THE BEST OF MY KNOWLEDGE AND BELIEF.
SIGNED ____________________________________ TITLE ________________________ DATE ____________
NOTE: THIS FORM MUST BE AN INK SIGNED ORIGINAL AND MUST ACCOMPANY THE PAYMENT DUE IN
st
OUR OFFICE ON OR BEFORE THE 21
DAY OF THE MONTH, IN ORDER TO AVOID ANY PENALTIES AND
.
INTEREST FEES
KINDLY MAKE YOUR CHECK, DRAFT, OR MONEY ORDER PAYABLE TO:
CUYAHOGA COUNTY TREASURER
:
MAIL ORIGINAL COPY OF COMPLETE RETURN WITH REMITTANCE TO
CCFO-Lodging Tax Dept.
Cuyahoga County Fiscal Officer
2079 E. 9th Street 3rd Fl. 121E
Lodging Bed Tax Dept.
Cleveland, OH 44115
nd
1219 Ontario St. 2
Floor
Cleveland, Ohio 44113-1021
Do not write
Below Official use only
DATE _________ CHECK# ________
AMOUNT $ ______________ R.R# __________
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Financial