Fillable Chico State Hotel Tax Waiver (California State University, Chico)

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Chico State Hotel Tax Waiver (California State University, Chico)

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CALIFORNIA STATE UNIVERSITY CHICO
FINANCIAL SERVICES
ACCOUNTS PAYABLE
KENDALL HALL ROOM 208
CHICO, CA 95929-0243
530-898-6426
www.csuchico.edu/ap
Hotel/Motel Transient
Occupancy Tax Waiver
Exemption Certicate
for State Agencies
HOTEL/MOTEL INFORMATION
Name:
Address:
City: State: ZIP:
AP: Hotel/Motel Transient Occupancy Tax Waiver Exemption Certicate for State Agencies Updated October 2014
STATE AGENCY INFORMATION
This is to certify that I, the undersigned traveler, am a representative or employee of the State agency
indicated below; that the char
ges for the occupancy at the above establishment on the dates set forth
below have been, or will be paid for by the State of California; and that such charges are incurred in the
performance of my ofcial duties as a representative or employee of the State of California.
Dates of Occupancy:
State Agency and Address: California State University, Chico
400 West First Street
Chico, CA 95929-0243
I hereby declare under penalty of perjury that the foregoing statements are true and correct.
Traveler:
Purpose: This form to be completed and retained by hotel/motel operator.
SIGNATURE PRINT NAME DATE
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Chico State Hotel Tax Waiver (California State University, Chico)

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Completed 19 July 2020

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