City of St. Helens
Transient Room Registration Form
*Plus State Surcharge 06/20/2018
P.O. Box 278, St. Helens, OR 97051 503-397-6272
The purpose of the transient room fee ordinance is to fund the promotion and development of tourism and visitor
programs in St. Helens. This request complies with Municipal Code 3.20, for transient lodging taxes and fees.
Contact Information
Name of property/business (including DBA) Tax ID number
Mailing address
City State Zip code
Physical address(es) of rental property (if different)
Name of operator/manager
Phone number
Email address
Name of transient room contact (if different)
Phone number Email address
Business Information
Affiliated companies or brands
If seasonal, which months are open?
Date business started operating
Website address
Type of business & number of spaces/rooms (check all that apply):
Bed & Breakfast
Camping
Other:
Hotel/Motel
Vacation Rental
Type of business organization:
Individual
Sole Proprietor
Partnership
Corporation
LLC
Government
Other:
Name of owners, partners, or corporate officers (use additional sheet if necessary):
Name Title Phone number
Mailing address
City State Zip code
Name Title Phone number
Mailing address
City State Zip code
I have read Municipal Code Section 3.20 Transient Room Fee, and fully understand my obligation to properly remit the monthly
transient room form and payment. I further understand that I must keep records, receipts, and other related documents for a
minimum of three years and in a form that the City can review at any time.
I declare, under penalty of making a false statement, that to the best of my knowledge and belief, the information herein is
true, correct, and complete.
Operator(s) Signature Date Signed
$125* Fire/Safety/Health Inspection Fee for First Time Applications
$50* Annual ReInspection Fee
FOR OFFICE USE ONLY
Date Rec: Received By:
DEQ Septic Approval Required?
Yes
No
Fee Paid: Receipt No.:
Approved
Denied By:
Planning Consent
Building Consent
Date Certificate Issued: By:
