Transient Lodging Tax Government Exemption Certificate Form - City Of Portland - Oregon

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Thomas Lannom, Director
CITY OF
111 S. W. Columbia, Suite 600
PORTLAND, OREGON
Portland, OR 97201-5840
(503) 823-5157
Fax: (503) 823-5192
BUREAU OF LICENSES
TDD: (503) 823-6868
An Equal Opportunity Employer
TRANSIENT LODGINGS TAX
GOVERNMENT EXEMPTION CERTIFICATE
Guest Name:__________________________________________ (please print)
on official business for _____________________________(printed name of Federal agency)
Name of Hotel/Motel:___________________________________________________________
Occupancy From: (check-in date)____________ To: (last date of occupancy) ___________
Total Rents Paid: ___________________
This is to certify that I, the undersigned, am an employee of the United States
Government Agency indicated below; that the charges for the occupancy at the above
establishment on the dates indicated above have been, or will be, paid for by such
Governmental Agency; and that such charges are incurred in the performance of my
official duties as an employee of such Governmental Agency. I also understand that I
must provide the hotel Operator with supporting documentation, as indicated below,
or the Operator must deny my request for exemption.
___________________________________ _______20__
(Signature of Federal Employee)
(Date)
*** IMPORTANT NOTICE TO FRONT DESK: Do not accept this certificate without one of
the following. DO NOT photocopy federal ID cards. ***
This certificate is NOT valid without attaching a copy of one of the following (check one):
Copy of official Federal travel orders (Government ID checked:
YES ________
initials)
Letter from Federal employer, on official Federal agency letterhead (Government ID
checked:
YES ________ initials)
Business card with Federal logo (Government ID checked:
YES ________ initials)
U.S. State Department identification card – blue stripe only (Blue Stripe verified:
YES
________ initials)
City of Portland Code Section 6.04.050 states no tax shall be imposed upon:
Any Federal Government employee travelling on official government business, who presents an
official Government Exemption Certificate or official travel authorization.
Transient Lodgings Tax Program

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