Form Return Of Short-Term Rental Property - City Of Falls Church

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CITY OF FALLS CHURCH
OFFICE OF THE COMMISSIONER OF THE REVENUE
300 PARK AVENUE
FALLS CHURCH, VA 22046 703-248-5019
RETURN OF SHORT-TERM RENTAL PROPERTY
MUST BE FILED FOR QUARTERS ENDING: MARCH 31, JUNE 30, SEPTEMBER 30 &
DECEMBER 31
QUARTER-PAYMENTS ARE DUE APRIL 20, JULY 20, OCTOBER 20 & JANUARY 20
LATE PAYMENT IS 10% OF TAX DUE OR $10.00 WHICHEVER IS GREATER
MAKE CHECK PAYABLE TO TREASURER, CITY OF FALLS CHURCH
SEE REVERSE FOR INSTRUCTIONS
ACCOUNT #:__________________________________
CERTIFICATE #:___________________________________
NAME: _______________________________________
LOCATION OF REPORTED PROPERTY: _____________________
MAILING ADDRESS:______________________________
________________________________________________________
_________________________________________________
TRADENAME (if applicable) : ______________________________
BUSINESS TELEPHONE #:
_____________________________
THE FOLLOWING INFORMATION MUST BE SUPPLIED:
The receipts reported are for the quarter ending : ______March 31, ______June 30, _______September 30, _______December 31.
Attach with this form an itemized list of all property, which you own or lease, used for short-term rental. Also attach your most recent
Federal depreciation schedule.
CALCULATION OF TAX
1. Gross Receipts From All Rentals…………………………………………………………………….$____________________
2. Gross Receipts From SHORT-TERM Rentals………………………………………………………..$____________________
3. EXEMPT RENTALS (see instructions on back):
A. Commonwealth of Virginia or the United States……………………………………………$____________________
B. Rentals exempt from Virginia Sales and Use Tax ………………………………………….$____________________
C. Rentals of durable medical equipment ……………………………………………………...$____________________
D. Total of lines (3a) through (3c) above ………………………………………………………$___________________
4. TAXABLE RENTAL RECEIPTS (line (2) less line (3d)……………………………………………$____________________
5. TOTAL TAX DUE (line (4) multiplied by (1%))…………………………………………………….$____________________
6. PENALTY (10% of Tax Past Due or $10.00; whichever is greater)………………………………… $___________________
7. Interest (10% per year on the sum of line 5 & 6)………………………………………………………$___________________
8. Total Daily Rental Paid (Add lines 5, 6, & 7)…………………………………………………………$___________________
PAYMENT MUST BE ENCLOSED WITH THIS RETURN
FAILURE TO FILE THIS RETURN MAY RESULT IN REVOCATION OF YOUR SHORT-TERM RENTAL CERTIFICATE
AND REASSESSMENT OF YOUR BUSINESS LICENSE AND BUSINESS TANGILE PERSONAL PROPERTY TAXES.
Use this form only to report short-term rental property owned by you. Do not include the items you report on the RETURN OF
TANGIBLE PERSONAL PEROPERTY & MACHINERY & TOOLS.
NOTE: It is a class 1 misdemeanor for any person to willfully sign a return, which he/she does not believe to be true and correct as to
every material matter (Code of Virginia, Section 58.1-11)
DECLARATION OF TAXPAYER:
I declare that the foregoing statements and figures are true; full and correct to the
best of my knowledge and belief.
Signature of Taxpayer:
___________________________________________________________________________Date_____________________________

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