Fillable Quarterly Report Form - Short-Term Rental - State Of Virginia printable pdf download

Post Office Box 189

ANN H. THOMAS

Yorktown, Virginia 23690-0189

Commissioner of the Revenue

(757) 890-3383

COUNTY OF YORK, VIRGINIA

FAX: 890-3380

E-mail:

revofc@yorkcounty.gov

QUARTERLY REPORT – SHORT-TERM RENTAL

Online Filing Form – *Due on or before the 20

day of the month following the Quarter being reported

(*If the due date falls on a Saturday, Sunday or legal Holiday, it is due the next business day)

This form will be processed within 24 hours (Monday thru Friday) of receipt, at which time you have the convenience to pay

online through the Treasurer’s website, , select “Pay Consumer/Excise Tax”; pay online thru E-

This form may be mailed, faxed or

emailed.

check (no convenience fee) or Credit Card (will be assessed a convenience fee).

Account No.:

Payment Submitted via: ▪ Mail ▪ E-check ▪ Credit

Card

Name:

Business Address (Street #, Street Name, Unit or Suite #):

Trade Name:

Mailing Address:

City/State/Zip:

Web Address:

Business Phone (including area code):

Email Address:

Quarter #

Months of

*Due Date

Quarter #

Months of

*Due Date

Jan, Feb, March

April 20

July, Aug, Sept

October 20

April, May, June

July 20

Oct, Nov, Dec

January 20

GROSS RECEIPTS FROM ALL RENTALS FOR QUARTER: ▪

▪

GROSS RECEIPTS FROM SHORT TERM RENTALS:

LESS ALLOWABLE DEDUCTIONS (List Required-submitted via: ▪ Mail ▪

Fax ▪ E-mail)

BALANCE OF TAXABLE GROSS RECEIPTS (Line 2 less Line 3):

TAX (1% of Line 4):

PENALTY IF LATE FILING (10% of Line 5 [$10.00 Minimum] ):

TOTAL TAX AND LATE FILING PENALTY (Line 5 + Line 6):

INTEREST IF RECEIVED AFTER THE *DUE DATE

Multiply Line 7 by .00833 for each month filed after the *Due Date. (Annual Rate of 10%)

TOTAL AMOUNT DUE (SUM of Line 7 + Line 8):

MAKE CHECKS PAYABLE TO: TREASURER – YORK CO

SUBMIT ALONG WITH PAYMENT - (or file and pay online)

NOTICE: This tax is held in trust until remitted to the County. In accordance with the state code § 58.1-3906 and § 58.1-3907 unless

otherwise described, the owner, corporate officer or employee, or member or employee of a general partnership or limited liability company

shall in addition to other penalties provided by law, be guilty of a Class 1 misdemeanor for failure to collect and remit these taxes. The

wrongful and fraudulent use of such collections shall constitute embezzlement pursuant to § 18.2-111.

OATH, I the undersigned applicant do swear (or affirm), that the foregoing figures and statements (for the period stated) are true, full and

correct to the best of my knowledge and belief and fully understand my obligations as stated in the above notice.

If submitting by EMAIL, this

form must be initialed below, which will be the equivalent of your signature. If submitting by MAIL or FAX, this form must be

signed.

______________________________________________

______________________________

__________________________________________

(including area code & extension)

Initials/Signature of person authorized to file

Title

Phone #

_____________________________________

_________________________________________

____________________________

_________________

Fax # (including area code)

Authorized person’s mailing address

E-Mail Address

Date

_____________________________________

_________________________________________

Alternate authorized person

Phone #

(including area code & extension)

Quarterly Report Form - Short-Term Rental - State Of Virginia

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