Short Term Rental Tax Remittance Form
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CITY OF SALEM, VIRGINIA
"DEDICATED TO CITIZEN SATISFACTION"
Linda M. Carroll
Commissioner of the Revenue
SHORT TERM RENTAL TAX REMITTANCE FORM
DATE
NAME
TRADE NAME
MAILING ADDRESS
LOCATION
GROSS RECEIPTS FOR ALL RENTALS:
1.
GROSS RECEIPTS FOR SHORT TERM RENTALS:
2.
COMPUTATION OF TAX (1% OF LINE 2):
3.
ENDING
QUARTER
MAKE
CHECK
PAYABLE
TO:
TR
EASURER,
CITY
OF
SALEM
MAIL TO: COMMISSION OF THE REVENUE, 114 N BROAD ST SALEM, VA
24153
I (we), the undersigned, hereby certify under penalty of perjury, that the information
correct to the best of my (our) knowledge and belief.
provided herein, is true and
___________________________________________
SIGNATURE
PRINTED NAME
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