COUNTY OF LOS ANGELES
TREASURER AND TAX COLLECTOR
TRANSIENT OCCUPANCY TAX
OVER THIRTY DAY STAY
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JOSEPH KELLY
TTC.LACOUNTY.GOV
EXEMPTION APPLICATION FORM
TREASURER AND TAX COLLECTOR
PROPERTY TAX PORTAL
The Los Angeles County Code, Section 4.72.070 L., states that an occupant of a hotel is a
transient, and therefore subject to the tax for the first 30 days of the occupant’s stay,
unless there is a written agreement in writing between the hotel’s operator and the
transient providing for a stay of more than 30 days. The written agreement must be
completed within the first 30 days of the person’s occupancy.
To qualify, the occupant and the operator must complete his/her respective sections of this
Exemption Application Form. Important- please complete in ink.
TO BE COMPLETED BY OCCUPANT
I HEREBY CERTIFY UNDER PENALTY OF PERJURY THAT THE INFORMATION IN
THIS FORM IS TRUE AND CORRECT. I understand that in signing this form I am staying
over thirty (30) consecutive days and I am therefore not considered a transient for the
purposes of the Transient Occupancy Tax.
By completing and signing this form it
constitutes an agreement with the operator, but is only valid with the signature of the
operator. In the event that I do not stay beyond thirty (30) consecutive days, I am liable to
the operator for the Transient Occupancy Tax upon check out.
Signature _______________________________________ Date ________________
Address
_____________________________________________________________
TO BE COMPLETED BY OPERATOR
I HEREBY CERTIFY UNDER PENALTY OF PERJURY THAT THE INFORMATION IN
THIS FORM IS TRUE AND CORRECT.
Name of Occupant (print)__________________________________________________
Name of Hotel/Motel___________________________________ Room No.________
Room Rate ________ Period of Residency (to) ____________(from) _____________
Name of Hotel/Motel Operator (print) ______________________________________
Date ________________ Signature _______________________________________
The completed Transient Occupancy Tax Over Thirty Day Stay Exemption Application Form is to be kept
with the operator and be made available for inspection by the Treasurer and Tax Collector. (Sec. 4.72.070).
The Los Angeles County Transient Occupancy Tax is codified in Title 4, Chapter 4.72 of the Los Angeles
County Code. Refer to Angeles County.
(Revised 01/15)
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