Print Form
Otsego County Room Occupancy Tax Return
Please read instructions on page two
1.
2.
NYS Sales Tax Identification
Name of Hotel/Motel
Number (optional)
Name of Operator (only if different from above)
3.
4. Certificate of Authority
6. PO Box (if any)
5.
7. Town/Village
8.Zip Code
Street Address
10. Name of Contact Person
11. Title or Position
12. Phone Number
PERIOD COVERED BY THIS RETURN
13. Quarterly (specify)
From __________________ , 20
To __________________, 20
COMPUTATION OF TAX
14.
Gross Income From Occupancy of Rooms During Period Covered By
$
Return
15.
Less Tax Exempt Sales
- $
$
16.
Net Taxable Income From Occupancy of Rooms
17.
County Occupancy Tax Due (4% of line 16)
$
18.
Penalty (10% of line 17 if tax not paid within 20 days of end of period covered this return)
+ $
+ $
19.
Interest (1% of line 17 for each month or fraction thereof if tax not paid within 30 days
of period covered by this return - no interest on first 30 days)
TOTAL AMOUNT DUE
$
20.
Under the penalties of perjury, I hereby declare that I have examined this return and the
information contained herein, and to the best of my knowledge belief the same are true, correct
and complete.
Signature
Print Name and Title
Date
MAKE PAYMENT PAYABLE TO "Otsego County Treasurer" AND MAIL WITH THIS RETURN TO:
Otsego County Treasurer
197 Main Street
Cooperstown, NY 13326
(607) 547-4346