Bristol Virginia Transient Occupancy Tax Form
Receipts for Month
Account Number: MT
Room Rental Receipts for Month: $_____________
.06% of Above Amount: $_____________
The Penalty is 5% of tax due.
Penalty (If Past Due) $_____________
Interest is 6% per annum computed on tax and penalty from due date.
Total Amount Due: $_____________
This return must be filed by the 20th day of each month following the month for which the
tax is due to avoid penalty and interest.
Please make all checks payable to the City Treasurer, Bristol, Virginia and mail the
Commissioner of the Revenue
497 Cumberland St.
Bristol, VA. 24201-4391
I hereby certify that the information provided in this form is accurate in accordance with
Article IX, Chapter 24 of the City Code of Bristol, Virginia.
Record of Payment: Date Paid