Lumpkin County Hotel Motel Tax Report Form printable pdf download

LUMPKIN COUNTY DELINQUENT HOTEL/MOTEL TAX REPORT FORM

INSTRUCTIONS: THIS FORM MUST BE COMPLETED IF THE REPORT IS NOT FILED AND THE TAX IS

OF THE MONTH. A COPY OF YOUR CORRESPONDING MONTH’S GEORGIA

NOT PAID BY THE 20

DEPARTMENT OF REVENUE SALES AND USE TAX REPORT FORM ST-3) MUST BE ATTACHED TO

THIS REPORT BEFORE IT CAN BE CONSIDERED COMPLETE.

BUSINESS NAME:_______________________________________________________________________________

GEORGIA SALES TAX NUMBER:__________________________________________________________________

LUMPKIN COUNTY BUSINESS LICENSE NUMBER:_________________________________________________

THIS REPORT COVERS TAX COLLECTED DURING THE MONTH OF:__________________________,20____

COMPUTATION OF AMOUNT TO BE REMITTED

1. Estimated Gross Rental Proceeds

$____________________________________

2. Estimated Exemptions

$____________________________________

3. Estimated Net Taxable Proceeds

$____________________________________

(Line 1 minus Line 2)

4. Estimated 5% Lodging Occupancy Tax

$____________________________________

(Line 3 times .05)

5. Late Payment Penalty

$____________________________________

(Line 4 times .15)

6. Interest on Late Payment

$____________________________________

(Line 4 times .085)

7. Non-Filing Penalty

$____________________________________

($25 for every month late)

8. Total to be Paid (Tax, Penalty and Interest)

$____________________________________

(Total of Lines 4, 5, 6, and 7)

Please make check for amount on Line 9 payable to the Lumpkin County Board of Commissioners and

forward with a copy of this report and your corresponding month’s Georgia Department of Revenue

Sales and Use Tax Report (Form ST-3) to:

Lumpkin County Board of Commissioners, Attn: County Clerk, 99 Courthouse Hill, Suite H,

Dahlonega, GA 30533. (706) 864-3742

STATEMENT: I DO HEREBY DECLARE UNDER PENATLY OF LAW THAT THE

INFORMATION CONTAINED IN THIS REPORT IS TRUE AND CORRECT TO THE BEST OF

MY KNOWLEDGE.

DATE:_____________________ SIGNATURE:___________________________________________

TITLE:___________________________________________

Lumpkin County Hotel Motel Tax Report Form