2014 Short-Term Rental Annual Certification Application Form - Virginia Finance Department

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2014 SHORT-TERM RENTAL
ANNUAL CERTIFICATION APPLICATION
(State Code Section 58.1-3510.2)
City of Alexandria, Finance Department, Revenue Administration Division
P. O. Box 178, Alexandria, VA 22313-1500
Phone: 703. 746.3903
alexandriava.gov/BusinessTax
(Application is to be completed by business owner for each location)
Account# ______________________
Virginia Sales Tax Number
___________________________________
_________
Approved
Business Telephone Number
___________________________________
_________
Denied
Date Business Began In City of Alexandria
___________________________________
OFFICE USE ONLY
Type of Rental Property:
Regular Short-Term
Heavy Equipment
Both
Owner Name: _________________________________________________________________________
Trade Name of Business: ________________________________________________________________
Headquarters Location: _________________________________________________________________
City of Alexandria Location: _____________________________________________________________
Mailing Address: ______________________________________________________________________
Business Contact Person: _______________________________________________________________
(NAICS Code 532412 or 532490)
Short-Term Rental
Short-Term Rental
(Regular) 80%
(Heavy Equipment) 60%
(PLEASE COMPLETE BOTH COLUMNS)
1. Enter your total gross rental receipts from the rental of all
owned personal property from the above location for the
past 12 months. Use an estimate if you have been in business
$__________________________
$__________________________
for less than 12 months
2. Subtract rental receipts for the provision of personal services
related to the personal property rented
$__________________________
$__________________________
[Code of Virginia, §58.1-3510 C. (ii)(iii)]
$__________________________
$__________________________
3. Adjust gross rental receipts (Line 1 minus Line 2)
4. Enter your gross receipts from owned items rented for 92
consecutive days or less, for heavy equipment 270 consecutive
$__________________________
$__________________________
days or less, including extensions and renewals
5. Subtract receipts for rentals made to persons affiliated with
the lessor if rented 92 days or less.
[Code of Virginia, §58.1-3510.6 B1 (ii)].
For heavy equipment rentals subtract receipts for rental made
to persons affiliated with the lessor if rented 270 days or less.
[Code of Virginia, §58.1-3510.6 B2 (iii)].
“Affiliated means “any common ownership interest in excess of
5% of any officers or partners in common with the lessor and
$__________________________
$__________________________
lessee”
$__________________________
$__________________________
6. Adjusted short-term rental receipts (Line 4 minus Line 5)
__________________________ %
__________________________ %
7. Percentage of daily Rental Receipts (Line 6 divided by Line 3)
The undersigned applicant declares that the figures and information contained in this application are true, complete and correct to the best of his/her
knowledge.
_________________________________________
_____________________________________
____________________________
Signature
Title
Date

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