PAGE 1
REVISED 12/1/2017
CITY OF LA GRANDE / UNION COUNTY
TRANSIENT ROOM TAX RETURN
OWNER__________________________________ BUSINESS NAME______________________________
BUSINESS ADDRESS___________________________________________PHONE____________________
NUMBER OF ROOMS__________ MONTH / YEAR COVERED____________________
1. Gross Rents-------------------------------------------------------------------------------------------$____________
2. Rent by the month----------------------------------------------------$____________
3. Rent less than $2 per day-------------------------------------------
$____________
4. Gross receipts from Transient Lodging Intermediaries ------$____________
(Use work sheet on page 2)
5. Total allowable deductions, total Lines 2 through 4 --------$____________
6. Taxable rents (subtract line 5 from line 1)----------------------------------------------------$____________
7. Tax @ 6% of line 6 (City of La Grande)---------------------------$____________
8. Tax @ 3% of line 6 (Union County)-------------------------------
-$____________
9. Add excess tax collected --------------------------------------------$____________
10. TOTAL TAX COLLECTED: (total lines 7, 8 & 9)------------------
$____________
11. Operator’s Collection Fee (5% of line 7)-------------------------$____________
12. Operator’s Collection Fee (5% of line 8)-------------------------$____________
13. TOTAL TAX DUE (subtract lines 11 & 12 from line 10)------------------------------------ $____________
14. PENALTY: (10% if fail to remit any tax imposed by Ordinance prior to delinquency.
A second delinquent penalty of 15% if 30 days past first delinquency.)
$____________
15. INTEREST: (.5% per month of the amount of tax due, excluding penalties, from the
Date on which the remittance first became delinquent until paid.)----- $____________
16. Adjustments for prior shortage or (overpayments)----------------------------------------
17. TOTAL TAX, PENALTY AND INTEREST: (line 13 through 15 or subtract line
16 if overpayment)---------------------------------------------------------------------------------$____________
I DECLARE, UNDER PENALTY OF MAKING A FALSE STATEMENT, THAT TO THE BEST OF MY
KNOWLWEDGE AND BELIEF, THE STATEMENTS HEREIN ARE CORRECT AND TRUE.
SIGNED____________________________________________DATE___________________________
SEND PAYMENT TO: CITY OF LA GRANDE PO BOX 670 LA GRANDE, OR 97850
Please call our office @ (541) 962-1313 if you have questions calculating interest or penalties
PAYMENTS ARE DUE BY THE 15
TH
OF THE MONTH FOLLOWING COLLECTION MONTH
DATE FILED _________________ CHECKED AND RECIEPTED BY_______________
