Form Tr1m - Monthly Transient Room Tax Return For Jefferson County
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1
2FORM
LOUISVILLE METRO REVENUE COMMISSION
1
TR
M
MONTHLY TRANSIENT ROOM TAX RETURN FOR JEFFERSON COUNTY, KENTUCKY
CHECK IF CHANGE IN ADDRESS IS BELOW
Name
________________________________________________________________________________
Address
________________________________________________________________________________
City
_________________________________
State ___________
Zip _______________
Ext
Federal ID _________________________________
Phone
_____________________
__________________
ACCOUNT NO
MONTH ENDING
DUE ON OR BEFORE
The Louisville and Jefferson County Convention and Visitors Bureau (“the Bureau”) has requested that the Louisville Metro Revenue
Commission collect and compile certain statistical information for the local hotel/motel industry. This statistical data will be transmitted
to the Bureau on a collective basis rather than individually to preserve the confidentiality of each taxpayer’s reported activity.
If you are reporting activity for one (1) property, complete the following section only. If you are reporting activity for more than one (1)
property, complete the back page of this return and report the totals below.
Name of Property
Number of Rooms
Owner
Operator
NUMBER OF ROOMS SOLD
Transient (Group)
1.
Transient (Individual)
2.
Permanent Guest
3.
Total Sold
(Line 1 + Line 2 + Line 3)
4.
DOLLAR VALUE OF ROOMS SOLD
Gross Room Sales
$
5.
Less Permanent Guest Sales
$
6.
Transient Room Sales
$
(Line 5 – Line 6)
7.
Total Transient Room Sales (Total of Line 7 for all properties
)
$______________
8.
Transient Room Tax
$
9.
(Line 8 x .075)
Interest
$
10.
Penalty
$
11.
Total Due
(Line 9 + Line 10 + Line 11)
$
12.
If any business ownership changed during this month, complete this section.
Date business changed ownership
1.
Name of property
2.
Name of new owner
3.
This payment records liability through
(Date)
4.
I hereby certify that the information and statements contained herein and any schedules or exhibits attached are true and correct.
Signature:
Title: _____________________
Date:
MAILING ADDRESS: P.O. BOX 35410 • LOUISVILLE, KENTUCKY 40232-5410
Telephone: (502) 574-4860 • • Fax: (502) 574-4818 • • TDD: (502) 574-4811
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