Lodger'S Tax Reporting Form

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LINCOLN COUNTY
PO BOX 970
CARRIZOZO, NM 88301
575-648-2397 or 800-687-2705
LODGER’S TAX REPORTING FORM
LINCOLN COUNTY ORDINANCE #2004-04
_____________________________________________________________________________
Business Name________________________________________________________________
Mailing Address________________________________________________________________
Physical Address_______________________________________________________________
City
State
Zip________________
Current Date
Report for Month of
Year
Gross Rent For Lodging:
$__________________
Subtract amounts received for rooms rented to vendees who
Have been a permanent resident of the premises for at
least 30 consecutive days:
$__________________
Subtract amounts received for room rent less than $2.00/day:
$__________________
Total Gross Taxable Rent For Lodging:
$__________________
Lodgers Tax Remitted (4% of Receipts)
$__________________
TH
*IF NOT RETURNED WITH THE REMITTANCE AND POSTMARKED OR PAID ON OR BEFORE THE 25
DAY
OF THE MONTH SUCCEEDING THE MONTH REPORTED YOU SHALL:
Add penalty of 10% or $100.00, whichever is Greater:
$__________________
Total Paid
$__________________
Total Rental Units in Facility:
________________
Number of Units available in Month:
________________
Number of Times Units were Rented:
________________
PENALTY FOR FAILURE TO MAKE PAYMENT OF TAX WHEN THIS REPORT IS DUE IS:
The Greater of 10% of the amount that was not duly remitted or $100.00.
Under penalty of perjury, I declare that I have examined this report and to the best of my
knowledge and belief it is true, correct and complete.
Authorized Signature:____________________________________________________________
_____________________________________________________________________________
Title:______________________________________Telephone #:_________________________
*When the last day for filing a report and payment of taxes falls on a Saturday, Sunday, or legal state or national
holiday, the act of filing the report and payment of taxes is timely if performed (paid or postmarked) on the next
succeeding day which is not a Saturday, Sunday, or a legal state or national holiday.
Revised Form: 05/25/04

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