Date:
This report is for month/quarter ending
"I declare, under penalties prescribed in Brazos County Order 07-003 dated August 28, 2007, (revised 04/01/2008) that the information contained in this
document is true and correct to the best of my knowledge and belief."
Signature:
PAYMENT IS DUE LAST DAY OF THE FOLLOWING MONTH.
Please remit the following:
(1) The amount due in the form
of a check or money order.
(2) An original of this report.
Remit to:
Brazos County, Texas
Treasurer's Office
200 S. Texas Ave, Suite 240
Bryan, Texas 77803
State
Revenue Code: 11051
GROSS RECEIPTS
Total Exemptions Claimed
Total Taxable Receipts
H.O.T. = % x Total Taxable Receipts
Venue Tax = % x Total Taxable Receipts
PENALTY @ 5%
AMOUNT DUE
STATEMENT
Please read the following carefully, then sign and date where indicated.
PAYMENT
Rev. 02/2011
BRAZOS COUNTY
REPORT OF HOTEL OCCUPANCY TAX
Treasurer's Office
200 S. Texas Ave, Suite 240
Bryan, Texas 77803
(979) 361-4340
State Taxpayer
Number:
Print Name:
Business
Name:
Mailing
Address:
Note:
A penalty will be assessed if
postmarked after the due date.
ADJUSTMENTS +/-
Phone
Number:
Email
Address:
2018