Form Hm-4 - Return Of Hotel Motel Tax - City Of Dayton printable pdf download

Form Hm-4 - Return Of Hotel Motel Tax - City Of Dayton

Return of Hotel Motel Tax:

Mail to: City of Dayton

Division of Revenue and Taxation

Form HM-4

PO Box 2806

For Period of___________ To____________

Dayton, Oh. 45401-2806

Account Number:______________________

Tele. (937) 443-3500

Fax. (937) 443-4280

Name_______________________________________________

Address_____________________________________________

City, State, Zip_______________________________________

1. Gross Receipts (All Hotel/Motel Lodging Furnished Guests)

______________

2. Exempt Receipts (Permanent Guests, Continuous Lodging Over 30 Days)

______________

3. Other Exemptions (Attach Exemption Certificates)

______________

4. Total Exempt Receipts (Add Lines 2 and 3)

______________

5. Net taxable Receipts (Line 1 Minus Line 4)

______________

6. Tax Due (Line 5 x .03)

______________

7. Adjustments - Prior Period - (Attach Explanation)

______________

8. Penalty (10% Per Month For Late Payment)

______________

9. Interest (1% Per Month For Late Payment)

______________

10. Total Amount Due (Add Lines 6, 7, 8, and 9)

______________

I hereby certify that the information and statements contained herein and in any schedule of exhibits are

true and correct.

Signature___________________________Title____________________________Date ______________

Notify the Division of Revenue and Taxation Promptly

Of Any Change in Ownership or Name and Address

Form Hm-4 - Return Of Hotel Motel Tax - City Of Dayton