Occupancy Tax Report Form - Currituck County Tax Office
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(OTP.rev.02_2011)
CONFIDENTIAL
RETURN TO:
Report for the Month of
CURRITUCK COUNTY TAX OFFICE
P. O. BOX 9
___________________________, 20______
CURRITUCK NC 27929
NOTE: REPORTS ARE DUE BY THE
TH
20
OF THE MONTH
CURRITUCK COUNTY
OCCUPANCY TAX REPORT
PHONE: 252-232-3005
FAX: 252-232-3568
Instructions on reverse side
Sale Tax I.D. # _____________________
Telephone:____________________________
Name of Firm/Owner______________________________________________________________________________
Mailing Address
______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
***If no income during reporting period, check here___________
***If SEASONAL, business will be closed from________________thru________________________,20_________
***If no longer in business, furnish date business ceased to operate___________________________,20_________
Provide gross receipts (round to nearest $) excluding tax collected. Enter by type and location.
LOCATION
TYPE
TOTAL GROSS RECEIPTS
CURRITUCK CO. OUTER BANKS
_____________________________ _________________________________________
CURRITUCK CO. MAINLAND
_____________________________ _________________________________________
TOTAL GROSS RECEIPTS:
_____________________________ _________________________________________
Multiply Total Gross Receipts By 6% and Enter Below
TAX:
________________________________________
LATE FILING PENALTY: _____________________________________ 5% PER MONTH* ($5.00 minimum)
(If applicable)
(*
per month or fraction thereof)
(see instructions 5A & 5B for Penalties)
LATE PAYMENT PENALTY: _____________________________________ 10% ($5.00 minimum)
TOTAL AMOUNT REMITTED: _____________________________________
MAKE CHECK OR MONEY ORDER PAYABLE TO: CURRITUCK COUNTY TAX OFFICE
CERTIFICATE OF TAXPAYER: This is to certify that this report, including all attachments, has been examined by me and is, to
the best of my knowledge and belief, a true and complete report made in good faith covering the month indicated above and that
same is in accordance with the books and records of the reporting taxpayer.
DATE:__________________________, 20_______
SIGNED:_______________________________________________
Report must be signed by owner of business, by partner if a partnership, or if a corporation by an authorized officer.
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