Form 12-100/form 12-101 - Texas Hotel Occupancy Tax Report
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1
2AB CD
*1210000W041726*
Be sure to print and sign your return.
12-100
b
b.
RESET FORM
PRINT FORM
(Rev.4-17/26)
Texas Hotel Occupancy Tax Report
under Chapters 552 and 559, Government Code,
You have certain rights
to review, request and correct information we have on file about you.
b
75100
Contact us at the address or phone number listed on this report.
Page 1 of ______
a. T Code
c. Taxpayer number
e.
d. Filing period
f. Due date
b
b
g. Name and mailing address (Make any necessary name changes below.)
IMPORTANT
h.
Blacken this box if any preprinted
R b
1.
information has changed. Show changes
beside the preprinted information.
Blacken this box if any location shown is no
R
2.
b
longer in business. Write the location number
and the date you went out of business below.
LOCATION
OOB
NUMBER
DATE
i.
j.
b
b
- A report must be filed even if no tax is due.
- Do not write in shaded areas.
b
b
b
1.
2.
3.
4.
5.
NUMBER
LOCATION TRADE NAME AND ADDRESS
LOCATION
TOTAL TAXABLE
TOTAL DOLLAR
OF ROOMS
NUMBER
AMOUNT OF
RECEIPTS
RECEIPTS
b
75180
k. T Code
b
(dollars)
(Item 4 from this and all supplemental pages)
6.
6. Total room receipts
for ALL locations
b
(dollars)
(Item 5 from this and all supplemental pages)
7.
7. Total taxable receipts
for ALL locations
b
(
% of Item 7)
6
8.
8. Total tax due
(If paid on time, enter 1% of Item 8)
9.
9. Discount
(Item 8 minus Item 9)
10.
10. Tax due after discount
12-100
(Rev.4-17/26)
(See instructions)
11.
11. Penalty
(See instructions)
12.
12. Interest
b
(Item 10 plus Item 11 and Item 12)
13.
13. TOTAL AMOUNT DUE AND PAYABLE
Taxpayer name
b
l.
m.
AB
b
b
b
T Code
Taxpayer number
Period
I declare that the information in this document and any attachments is true
and correct to the best of my knowledge and belief.
Duly authorized agent
Make the amount in Item 13 payable to
STATE COMPTROLLER
Daytime phone
Mail to Comptroller of Public Accounts
Date
(Area code and number)
P.O. Box 149356
Austin, TX 78714-9356
For assistance call 1-800-252-1385 .
111 A
Information is also available at
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