Lodgings Tax Form printable pdf download

Lodgings Tax Form

CITY OF BESSEMER

REVENUE DEPARTMENT

1806 3

AVENUE NORTH

BESSEMER, AL 35020

(205) 424-4060 FAX (205) 425-2820

LODGINGS TAX

ACCOUNT NUMBER __________

In compliance with the Revenue Laws of the City of Bessemer,

I, ___________________________________, ________________________________,

NAME

TITLE/POSITION

for and in behalf of ____________________________________________________________ at

_________________________________________________________________________ being the

ADDRESS

CITY/STATE/ZIP

person duly authorized to make such statement, do hereby certify under oath that the gross collections for

rooms rented for the month ending ________________________, 20 ______, in the City of Bessemer

amounted to _____________________.

The 3% tax on these collections due to the City is _______________.

Payment is due by the 20

of the following month. Make all checks/money orders payable to “CITY OF

BESSEMER”.

_____________________________________

SIGNATURE

Sworn to and subscribed before me this the __________day of _____________________, 20 ______.

____________________________________

NOTARY PUBLIC

Lodgings Tax Form