Hotel Motel Tax Collection Form - Hardy County West Virginia

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HARDY COUNTY, WEST VIRGINIA
HOTEL/ MOTEL OCCUPANCY TAX RETURN
P.O. Box 643
Moorefield, WV 26836
Phone: (304) 530-0220
Fax: (304) 530-0223
Hotel/ Motel Name:
_________________________________________________
For the Month Ending:
_________________________________________________
Occupancy Receipts
$______________________________
(Less Adjustments****)
$______________________________
Total Adjusted Receipts
$_________________________________
6% of Total Adjusted Receipts
$___________________________
Penalty (5%) for late payment
$___________________________
TOTAL TAX REMITTED TO SHERIFF
$_________________________
DECLARATION
I do hereby declare that the statements and items (both as to designation and amounts)
entered in the foregoing returns and in the supplementary statement are to the best of my
knowledge and belief true and correct in each and every particular.
_______________________________
__________________
_______________
Name of Taxpayer
Title
Date
Instructions:
Please complete the above information in its entirety and return the form with
accompanying check made payable to the Sheriff of Hardy County to the address above.
****Please attach list of transactions including the name(s), date(s) of stay, and amount(s)
that were not charged the Hotel/Motel Occupancy Tax during the reporting month.
Missing or incomplete information will result in your return being returned to you.
If you have any questions regarding the Hotel/Motel Occupancy Tax or if you need
assistance in completing your return, please contact our office at (304) 530-0220.

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