Short Term Rental Tax Report Form - City Of Chesapeake, Virginia

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SHORT TERM RENTAL TAX REPORT
CITY OF CHESAPEAKE, VIRGINIA
Return to: Ray A. Conner, Commissioner of the Revenue
PO Box 15285, Chesapeake, VA 23328-5285
(757) 382-6738 or 382-6739
ACCOUNT #:
QTR ENDING:
1. RECEIPTS 92 DAYS OR LESS:
2. RECEIPTS MORE THAN 92 DAYS:
3. TOTAL GROSS RECEIPTS:
(LINE 1 PLUS LINE 2)
CERTIFIED SIGNATURE
DATE
4. TOTAL EXEMPT SALES:
5. RECEIPTS SUBJECT TO TAX:
Applicant Name
6. TAX: 1% OF LINE 5:
(Trade Name)
7. PENALTY:
(Mailing Address)
8. INTEREST:
(City, State, Zip)
9. PRIOR BALANCE DUE:
10. TOTAL TAX DUE
RETURN DUE AND PAYABLE ON OR BEFORE 20TH DAY OF REPORTING MONTH
MAKE CHECKS PAYABLE TO CITY OF CHESAPEAKE (YOUR CHECK IS YOUR RECEIPT)
(Complete and return upper portion with payment)
RETAIN THE LOWER PORTION OF THIS WORKSHEET FOR YOUR RECORDS
(Use receipt figures for the reporting quarter)
1
GROSS RENTAL RECEIPTS 92 DAYS OR LESS
2
GROSS RENTAL RECEIPTS GREATER THAN 92 DAYS
3
ADD LINES 1 AND 2 = TOTAL GROSS RENTALS
4
DEDUCT VIRGINIA STATE SALES TAX COLLECTED (5%)
5
DEDUCT CITY SHORT TERM RENTAL TAX COLLECTED (1%)
6
DEDUCT ANY EXEMPT RENTALS (CERTIFICATES ON FILE)
RECEIPTS SUBJECT TO CITY SHORT TERM RENTAL TAX
7
8
MULTIPLY LINE 6 BY .01 (1.0%) = Tax Amount Due
REMIT THIS AMOUNT
DATE __________________
CHECK NUMBER _______
Make Checks Payable to CITY OF CHESAPEAKE
If remitting late payment after the 20th of the month deadline :
9
Multiply the tax amount due (line87) by .10 (10%) = Penalty
10 Add line 9 to line 8 and multiply by .0083 = Interest
11 Add lines 8, 9, & 10 and remit Total Payment
If the upper portion of this form shows a prior balance due, add that amount to your
check. If the prior balance due is a credit (-), deduct this amount from your check.
If you have any questions please contact:
Commissioner of the Revenue's Office
PO Box 15285, Chesapeake, VA 23328-5285
(757) 382-6738 or 382-6739
Fax: (757) 382-8822
E-Mail: bustax@comrev.city.chesapeake.va.us

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