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Application For Certification As A Short-Term Rental Business Form - City Of Norfolk, Virginia Page 2

City of Norfolk

C. Evans Poston, Jr., Commissioner of the Revenue

Short-term Rental Business

Instructions for Completing Application for Certification

Business Information:

Applicant Name — Enter the name of business owner(s) or corporation name.

Trade Name — Enter the name under which the business is operating.

Business Location — Enter the location address of the business.

Mailing Address and Telephone Number — Enter the mailing address and the telephone number.

Business Tax Contact — Enter the name of the person to contact if there are any questions regarding

this return.

Date Business Began in City of Norfolk — Enter the date this business began at this location in the

City of Norfolk.

Type of Rental Property — Enter the type(s) of property rented, (for example, video-tapes).

Federal Tax Identification Number — Enter your Federal ID number in the space on the form provided

for this information.

Virginia Sales Tax Number — Enter your Virginia sales tax registration number.

Gross Receipts Information:

Line 1: Enter the total gross receipts from all business conducted by the applicant at the business

location for the period indicated. This includes gross receipts that may be attributable to business

other than the rental of property.

Line 2: Enter the total gross rental receipts from all rental property for the period indicated.

Line 3: Enter the total gross receipts earned from short-term rental. Short-term rental is any property

rented for a term of ninety-two (92) consecutive days or less.

Line 4: Enter the total gross receipts earned from Short-term Rental property leased to persons affiliated

with the lessor. The term affiliated means any common ownership interest in excess of five

percent (5%) of any officers or partners in common with the lessor and lessee.

Line 5: Enter the adjusted Short-term Rental proceeds. (Subtract line 4 from line 3)

Note:

This application for certification is subject to a full record review.

Questions?

If you have any questions or desire assistance in completing the certification application please contact

the Commissioner of the Revenue, Business Tax Department at (757) 664-7886.

PLEASE REMEMBER TO SIGN YOUR APPLICATION

Application For Certification As A Short-Term Rental Business Form - City Of Norfolk, Virginia Page 2