Form Rst-Cr - Complimentary Rooms - Indiana Departent Of Revenue

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Form RST-CR
Complimentary Rooms
(12-03)
This form is for information only.
Authorized
X
If you do not furnish complimentary rooms or lodgings, you do not need to complete this form.
Signature
I declare under penalties of perjury that this is a true, correct and complete voucher.
(
)
Date
Phone #
Total Quantity of Accommodations Rented .................... A.
.
,
,
$
Sales Tax Remitted for the Amount on Line A .............. B .
Taxpayer ID Number
Total Quantity of Complimentary Accommodations .... C .
.
,
,
$
Sales Tax Remitted for the Amount on Line C ............... D.
For Tax Period
(Please check month)
Send no money with this voucher. Payments should be submitted with the ST-103.
J
M J J
A
S O N
F M
A
D
Business Name
INDIANA DEPARTMENT OF REVENUE
DBA Name
P.O. BOX 6105
Street address
INDIANAPOLIS, IN 46206-6105
City
State
Zip
R

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