Transient Occupancy Tax Registration For Spotsylvania County Form

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TRANSIENT OCCUPANCY TAX REGISTRATION
FOR SPOTSYLVANIA COUNTY
Office Use Only
COMMISSIONER OF THE REVENUE
DEBORAH F WILLIAMS
Business Acct. # _________
PO BOX 175
SPOTSYLVANIA, VA 22553
Phone: (540) 507-7051
SECTION A – Owner & Business Information
1.
Owner’s Name:
________________________________________________________________________________________________
(If a Corp, S Corp, LLC, etc then please give the name as filed with the State of Virginia)
2.
Mailing Address:
_____________________________________________________________________________________________
PO Box or Block/Street Name
City
State
Zip
3.
Social Security #
Social Security #
Fed Employer Id #
______-_____-_____
_____-_____-_____
______-________________
4.
Trade Name:
___________________________________________________________________________________________________
5.
Physical Address:
______________________________________________________________________________________________
Block/ Street Name (No PO Boxes)
City
State
Zip
(
) ____-______ ext ____
(
) ____-_______ ext _____
6.
Owner’s Phone
Business Phone
SECTION B – Type of Business:
Sole Proprietor
Partnership
Corporation
Other
If Va Corp, give date of charter: ____ / ____ / ____
If foreign corp, give date of qualification in Va: ____ / ____ / _____
Registered Agent’s Name: ______________________________________________________________________________
Mailing Address: ______________________________________________________________________________
P O Box or Block/Street Name
City
State
Zip
:____________________________________________________
SECTION C – Description of Business
(example: bed & breakfast, hotel, motel, etc.)
SECTION D – Retail Merchants
Va State Sales Tax Registration #___________________
SECTION E – Start Date :
_____/____/____
Mnth
Day
Yr
SECTION F – Declaration
FOR OFFICE USE ONLY
I, the undersigned, hereby certified under penalty of
perjury, that the information provided herein and
Business Property #__________________
above, is true and correct to the best of my/our
knowledge and belief.
Reviewed by _________________________
Date ________________________________
_______________________________ __________
Signature of Applicant for License
Date
Additional Info _______________________
_______________________________ __________
or Authorized Agent
Date
_____________________________________
(rev 8/08)

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