Form Sth20006 - County Lodging Tax Return
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1
2STH
20006
Revised 10-2012
County Lodging Tax Return
E. Amended Return
A.Taxpayer FEIN/SSN
B. Reporting Period
C. Due Date
D. Account Number
01
H. Page ______ of ______ Page(s)
G. Mailing
Date Out
Address Change
of Business: __________________
MM/DD/YY
F. Out of Business
-Office Use Only-
G. New Mailing Address
_________________________________________________________
_________________________________________________________
Address
Name
_________________________________________________________
_________________________________________________________
City
State
ZIP
Address
_________________________________________________________
City
State
ZIP
- - - - - - - - - - - - Dollars - - - - - - - - - - - -
- - - Cents - - -
00
1. Total Sales .................................................................................................................................1. _______________________________ . ____________
00
2. Exemptions............................................................................................................................. - 2. _______________________________ . ____________
00
3. Net Taxable Sales (Line 1 minus Line 2) ............................................................................... = 3. _______________________________ . ____________
4. County Tax (Sum of line(s) N. of Column M from schedule below
and supplemental pages) ......................................................................................................... 4. _______________________________ . ____________
5. Discount (limit $2,500.00)....................................................................................................... - 5. _______________________________ . ____________
6. Interest .................................................................................................................................. + 6. _______________________________ . ____________
7. Penalty .................................................................................................................................. + 7. _______________________________ . ____________
8. Total Due (If no tax is due, enter ‘0’) ..................................................................................... = 8. _______________________________ . ____________
Please remit only one check per return.
County Tax Schedule
K. Net Taxable Sales Subject
M. Amount of Tax Due
to Lodging Tax
(Multiply Item K by Item L)
L. Tax Rate
I. County Code
J. County Name
- - - Whole Dollars Only - - -
(%)
- - - Dollars - - -
Cents
9
10
11
12
13
14
15
N. TOTAL (if more space is needed, use supplement page[s])
Signature: _____________________________________________________
Date: ___________________________
The information contained in this return and any attachments is true and correct to the best of my knowledge.
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Parent category: Financial