Montgomery County
Commissioner of the Revenue
Helen P. Royal, Master Commissioner of the Revenue
INSTRUCTIONS:
1. Complete this form.
2. Make check payable to: Treasurer, Montgomery County
3. Mail form and check to the following address:
QUARTER ENDING THE MONTH OF
Name of Hotel, Motel or Other Lodging Place:
County Location Address:
Mailing Address:
Phone Number: Email:
Total Receipts from Room, Lodging, or Space Rental: $
Times the Rate: X
TOTAL TAX: $
Signature of Owner, Partner or Officer:
Date:
www.MontVa.com • 540-382-5710 • Fax 540-381-6838
REPORT OF TRANSIENT OCCUPANCY TAX COLLECTED
Commissioner of the Revenue
County of Montgomery
755 Roanoke St. Suite 1A
Christiansburg, VA 24073
Report and payment due on or before the 20th day following the end of the quarter.
3%
Post Mark Date:
Taxpayers - Do not write below this line
Walk-in / Drop box Date: