Form Nyc-Htx Draft- Hotel Room Occupancy Tax Return
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5-HTX
HOTEL ROOM OCCUPANCY TAX RETURN
TM
F O R U S E B Y O P E R A T O R S A N D R O O M R E M A R K E T E R S
Department of Finance
Period beginning ________-_________-________
Period ending ________-_________-________
Legal Name:
Name
n
EMPLOYER IDENTIFICATION
Change
NUMBER:
____________________________________________________________________________
Trade Name:
OR
____________________________________________________________________________
SOCIAL SECURITY
In Care of:
NUMBER:
____________________________________________________________________________
Location Address (number and street):
Address
n
ACCOUNT
Change
____________________________________________________________________________
ID:
City and State:
Zip Code:
Country (if not US):
____________________________________________________________________________
FEDERAL BUSINESS
Business Telephone Number:
Taxpayer’s Email Address:
CODE:
n
n
n
Check type of business entity:
Corporation
Partnership or LLC
Individual, estate or trust
nn-nn-nnnn
nn-nn-nnnn
n
n
Initial return: Date business began
Final return: Date business ended
nn
n
n
Enter 2‑character special condition code, if applicable. (See inst.):
Amended return
Hotel Remarketers please check box
Operators must enter the following information in order for this return to be complete:
a. If this is a final return, check the "final return" box above and, if there is a new operator, please enter the new
operator’s name, otherwise, enter “None”:
a.
___________________________________________
.............................................................................................................................................................................................
b. Number of rooms available to transient occupants at the above hotel (see instructions)
b.
................................................................
c. Number of rooms rented to permanent residents at the above hotel (see instructions)
c.
n
d. If you are an operator renting out apartments or living units under a single certificate of authority in more than one building, check this box and attach an addendum:
d.
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
e. Billing address, if different
from the address above ):___________________________________________________________________________________________________________________
NUMBER AND STREET
CITY
STATE
ZIP CODE
COUNTRY
SChEDUlE A
C o m p u t a t i o n o f T a x
Payment Amount
A. Payment
Amount being paid electronically with this return............................................................ A.
RENT CATEgORIES
TAx RATE
TAx DUE
NUMbER OF TAxAblE ROOM RENTAlS
(
)
(
)
(
#
)
SEE INSTRUCTIONS
PER ROOM AND DAy
TAx RATE x
OF TAxAblE ROOM RENTAlS
DURINg ThIS TAxAblE PERIOD
1. $ 10 - $19.99
$ 0.50
1.
.............................................................
2. $ 20.00 - $29.99
$ 1.00
2.
....................................................
3. $ 30.00 - $39.99
$ 1.50
3.
....................................................
4. $ 40.00 and over
$ 2.00
4.
..................................................
’
(
)
ADDITIONAl TAx DUE
TAx RATE
TOTAl RENTS DURINg ThIS TAx PERIOD
ADD
l TAx DUE
TAx RATE x TOTAl RENTS
5. Additional Tax
5.
5.875%
6. Total of lines 1 through 5
6.
......................................................................................................................................................................................................................................................
7. Total tax collected (see instructions)
7.
.................................................................................................................................................................................................................
8. Tax before refunds and/or credits (greater of lines 6 or 7)
8.
..............................................................................................................
9. Refunds and/or credits (attach schedule) (see instructions)
9.
...........................................................................................................
10. Total tax due (line 8 less line 9)
10.
.......................................................................................................................................................................................
11. Less: (a) Prepayments for the period
11a.
..............................................
(b) Credits carried from previous tax return
11b.
............
12. Total of lines 11a and 11b
12.
.....................................................................................................................................................................................................
13. Balance due (line 10 less line 12)
13.
...............................................................................................................................................................................
14. Overpayment (line 12 less line 10)
14.
............................................................................................................................................................................
15. Amount of line 14 to be: (a) Refunded
15a.
................................................................................................................................................................
(b) Credited to next quarter’s tax
15b.
.........................................................................................................
16. Interest (see instructions)
16.
.......................................................................................................................................................................................................
17. Penalty (see instructions)
17.
.......................................................................................................................................................................................................
18. TOTAl REMITTANCE DUE (line 13 plus lines 16 and 17)
18.
..................................................................................................................
C E R T I F I C A T I O N
O F
T A x P A y E R
Firm’s Email Address
I hereby certify that this return, including any accompanying schedules or statements, has been examined by me and is, to the best of my knowledge and belief, true, correct and complete.
I authorize the Dept. of Finance to discuss this return with the preparer listed below. (see instructions) .....................................yES
n
_____________________________________________
____________________________________
___________________
__________________
________________
Preparer’s Social Security Number
Signature of owner, partner or corporate officer
T
T
N
Date
ITLE
ELEPHONE
UMBER
_________________________________________
__________________________________
___________________
Preparer’s signature
P
’
D
REPARER
S PRINTED NAME
ATE
Firm’s Employer Identification Number
n
Check if
_____________________________
__________________________________
______________
Firm’s name
Address
Zip Code
Self-Employed:
Make remittance payable to the order of
All RETURNS ExCEPT REFUND RETURNS
REMITTANCES
RETURNS ClAIMINg REFUNDS
NyC DEPARTMENT OF FINANCE.
PAy ONlINE wITh FORM NyC-200V AT
NyC.gOV/ESERVICES
NYC DEPARTMENT OF FINANCE
Payment must be made in U.S. dollars,
NYC DEPARTMENT OF FINANCE
OR
HOTEL TAX
HOTEL TAX
Mail Payment and Form NyC-200V ONly to:
drawn on a U.S. bank.
P.O. BOX 5564
P.O. BOX 5563
NYC DEPARTMENT OF FINANCE
40011891
BINGHAMTON, NY 13902-5564
BINGHAMTON, NY 13902-5563
P.O. BOX 3933
NyC-hTx 2017
NEW YORK, NY 10008-3933
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