Transient Lodgings Tax Quarterly Report - City Of Portland Bureau Of Licenses

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CITY OF
Transient Lodgings
PORTLAND, OREGON
Tax
BUREAU OF LICENSES
Quarterly Report
An Equal Opportunity Employer
Hotel/Motel Name_______________________________________ TL Tax Account No.___________________
Address ________________________________________________ Total Rooms _________________________
Operator Name __________________________________________ Phone _______________________________
Report for Quarter/Month Ending ________________________ Date _________________________________
E-mail Address _________________________________________
RENT RECEIPTS:
1.
Gross Rents
2.
Other
3.
TOTAL RECEIPTS (Line 1 & 2)
ALLOWABLE DEDUCTIONS:
4.
Rent by Month
5.
Government Exemptions
6.
Uncollectibles
7.
Other Deductions
8.
TOTAL DEDUCTIONS (Lines 4 through 7)
9.
TAXABLE RENTS (Line 3 minus Line 8)
TAX COLLECTED:
10.
Tax Collected (11.5% of Line 9)
11.
Less Expense Allow. (Line 9 x .00275)
12.
TOTAL TAX COLLECTED (Line 10 minus Line 11)
ADDITIONS & ADJUSTMENTS:
13.
Extension Interest (1.25%) Requires prior authorization
14.
Penalty (10% 1st month, 15% 2nd month)
15.
Interest (00767 [.76%] per month or fraction of)
16.
Adjustment for Prior Period
17.
Tax Collected, not returned to Transient
18.
TOTAL ADJUSTMENTS (Lines 13 through 17)
19.
TOTAL REMITTANCE
*** PAYMENT MUST BE POSTMARKED BEFORE THE DELINQUENT DATE ***
I declare, under penalty of making a false statement, that to the best of my knowledge and
belief, the statements herein are correct and true.
Signed
Title _________________________________________
For Official Use Only:
Postmark _____________
Make Checks Payable to: CITY OF PORTLAND
Remit to: Bureau of Licenses - TL Division
111 SW Columbia, St., Ste 600 OR 97201-5840
Underpayment _________________
Overpayment ________________
Check # ___________
Verified By: ___________

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