Transient Occupancy Tax Designated Exemptions Application Form - County Of Los Angeles

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COUNTY OF LOS ANGELES
TREASURER AND TAX COLLECTOR
TRANSIENT OCCUPANCY TAX
DESIGNATED EXEMPTIONS
JOSEPH KELLY
HOME PAGE
APPLICATION FORM
TTC.LACOUNTY.GOV
TREASURER AND TAX COLLECTOR
PROPERTY TAX PORTAL
The Los Angeles County Code, Chapter 4.72 Transient Occupancy Tax, Section 4.72.060 Exemptions, states “If
a proper claim for exemption is made a tax shall not be imposed.” The following designations are considered
exempt: emergency shelter referrals by Los Angeles County, County-affiliated, or State agencies, including, but
not limited to, referrals from the Los Angeles County Department of Public Social Services, the Department of
Children and Family Services, the Los Angeles Homeless Services Authority, and the State Department of
Corrections and Rehabilitation; any Federal or State employee on official business; any officer or employee of a
foreign government; and, any Red Cross, Amtrak, US Postal Service, Federal Credit Union and Insurance
Company employee serving on official business.
If you meet the above criteria and are exempt from the tax, file this Application Form and state those facts,
declared under penalty of perjury, which qualify you for the exemption. An exemption shall not be granted to any
transient except upon the submission of this Application Form made at the time rent is collected.
Please check off and initial the appropriate designation:
Amtrak
Foreign Government Agency
Emergency Shelter Referral
Insurance Company
Federal Credit Union
Red Cross
Federal or State of California employee
US Postal Service
I HEREBY CERTIFY UNDER PENALTY OF PERJURY THAT THE INFORMATION IN THIS
FORM IS TRUE AND CORRECT.
Signature of person claiming exemption: _________________________________
Print Name:
________________________________________________________
Organization:
_______________________________________________________
Telephone Number:
__________________________________________________
Check in Date: ___________________
Check out Date: __________________
Signature of Hotel/Motel Operator:
_______________________________________
DBA/Address: _______________________________________________________
The completed Transient Occupancy Tax Exemption Application Form is to be kept with the operator and made
available for inspection by the Treasurer and Tax Collector. (Sec. 4.72.070).
The Los Angeles County Transient Occupancy Tax is codified in Title 4, Chapter 4.72 of the Los Angeles
County Code. Refer to Angeles County.
(Revised 01/15)

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