UNIFORM TRANSIENT OCCUPANCY TAX REGISTRATION FORM
ORDINANCE NO. 495 AS AMENDED
COUNTY OF RIVERSIDE, STATE OF CALIFORNIA
DATE: _______________________
CERTIFICATE NO.____________
(To be assigned by the Treasurer/Tax Collector)
PLEASE PRINT OR TYPE
1.
Name of Operator and Title: _________________________________________________________________________________
(See Section 2(f) of Ordinance No. 495 as amended for definition of operator)
2.
Business Name: __________________________________________________________________________________________
3.
Business Address: _________________________________________________________________________________________
Email Address:
4.
Business Phone: (
) _____________________
5.
Business Mailing Address: __________________________________________________________________________________
6.
Assessment Number of last Riverside County Tax Bill covering the business: _______________________________________
7.
How long have you operated the business? ________________________
8.
Type of Organization: Individual __________ Partnership __________ Corporation __________
Other (Please specify): _____________________________________________________________________________________
9.
If Operator is not Owner of Business, Complete the following:
Owner: _________________________________________________________________
Address: _______________________________________________________________
Email Address:
Telephone Number: (
) _____________________
10.
Names of Partners or Corporation Officers:
(Name)
(Title)
(Address)
(Name)
(Title)
(Address)
11.
Number of Occupancy Units:
Total No. of Units: _________
________@ $________
________@ $________
_______@ $_______
12.
Percentage of Occupancy (From Experience): _______________
13.
If item #9 of this form was not completed, the complete legal description of the real property upon which this business is
located must be provided: __________________________________________________________________________________
_________________________________________________________________________________________________________
SIGNATURE: ________________________________________
TITLE: ________________________________________
Return This Registration Form to the Riverside County Treasurer/Tax Collector. Send to:
DON KENT
RIVERSIDE COUNTY TREASURER/TAX COLLECTOR
POST OFFICE BOX 12005
RIVERSIDE, CA 92502-2205
ATTENTION: Transient Occupancy Tax Registration
For Questions Regarding the Transient Occupancy Tax Registration, Contact the Riverside County Treasurer/Tax Collector’s Office at (951) 955-3931