Form H-1 - Return Of Hotel & Motel Excise Tax - City Of Brook Park

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City of Brook Park
1. GROSS RECEIPTS FOR LODGING FURNISHED $
RETURN OF HOTEL & MOTEL EXCISE TAX
FORM H-1
MONTH
YEAR
ACCOUNT NUMBER
DUE ON OR BEFORE
2. LESS ALLOWABLE DEDUCTIONS INCLUDED
ON LINE 1 (Ordinance #4054, S
. 1-1903-1904)
EC
ATTACH CERTIFICATES OR EXPLANATIONS.
$
FILE TAX RETURNS AND PAY TAXES PROMPTLY TO AVOID PENALTIES.
NOTIFY DEPARTMENT OF TAXATION PROMPTLY OF ANY CHANGE IN OWNERSHIP AND ADDRESS.
3. NET TAXABLE RENT
$
4. TAX DUE (3% OF LINE 3)
$
5. ASSESSMENT 11 1/2% PER MONTH OR
FRACTION THEREOF.
$
SIGNATURE AND TITLE
DATE
I DECLARE THAT THIS RETURN HAS BEEN EXAMINED BY ME, AND TO THE BEST OF MY
KNOWLEDGE AND BELIEF IS A TRUE, CORRECT AND COMPLETE RETURN, MADE IN GOOD
6. TOTAL TAX, AND PENALTY IF ANY, PAID
FAITH, PURSUANT TO CITY OF BROOK PARK TAX ORDINANCE AND REGULATIONS.
HEREWITH.
$
MAKE CHECK OR MONEY ORDER PAYABLE TO CITY OF BROOK PARK, OHIO
DEPARTMENT OF TAXATION, 6161 ENGLE ROAD, BROOK PARK, OHIO 44142

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