A. GROSS
Total Room Rent Revenue
REPORTED
ACTUAL
DIFFERENCE
1
st
Quarter
2
nd
Quarter
3
rd
Quarter
4
th
Quarter
B. GROSS TOTALS
C. EXEMPT
Room Rent Revenue from Organizations exempt from WI Sales Tax
REPORTED
ACTUAL
DIFFERENCE
1
st
Quarter
2
nd
Quarter
3
rd
Quarter
4
th
Quarter
Gross Total Difference (B) minus Exempt Total Difference (D)
D. EXEMPT TOTALS
E. DIFFERENCE
F. ROOM TAX
Total Difference Amount (E) times 3%
AMOUNT DUE TO CITY
If Total Difference Amount (E) is a negative amount, credit due to Owner
I certify that the above figures are true and correct.
Dated this day of , 2021.
Owner/Agent Signature
Contact Name:
Phone Number and/or email:
Please forward this report to City of Hudson, Attn City Treasurer, 505 3
rd
St, Hudson
WI 54016, on or before March 30, 2021.
CITY OF HUDSON - 505 THIRD ST, HUDSON WI
2020 ANNUAL ROOM TAX SUMMARY SHEET
Company Name
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
CLEAR
PRINT
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