Commissioner or Revenue, Clarke County
P.O. Box 67, Berryville, VA 22611
(540) 955-5108 Fax: (540) 955-5179
WORK SHEET/REPORT FROM FOR TRANSIENT
OCCUPANCY TAX
Report Period: ____________________
1. Gross Rentals (Report on Line 1, Tax Return From): $_________________
2. Allowable Deductions: $_________________
a. Exempt Rentals (over 30 days) $_________________
b. Refund of rentals included in line 1: $_________________
c. Return of rentals included in prior reports: $_________________
d. Other (please state):_____________________ $_________________
e. Total Deductions (total a thru d) $_________________
(report on line 2 of tax return) $_________________
3. Item 1 less item 2e: (report on line 3, tax return) $_________________
4. Tax (2% of item 3) (report on line 4, tax return) $_________________
5. Less Commission (3% of line 4) (report on line 5) $_________________
(Do not compute if report is delinquent)
6. Tax Due: (Line 4 less line 5) (Report on line 6, tax return) $_________________
Keep worksheet, above. Detach report from, below.
The form below must be signed and returned with your payment.
Check should be make payable to the Treasurer of Clarke County,
and Mailed to the Commissioner of Revenue, P.O. Box 67, Berryville, VA 22611
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COUNTY OF CLARKE
Transient Occupancy Tax Return
Business Name & Address _________________________________________
Report Period: _____________________________________
1. Total Gross Sales: $________________
2. Total Deductions: $________________
3. Amount on which to compute tax: $________________
4. Amount of Tax: $________________
5. Less Commission: $________________
6. Total Tax Due: $________________
To the best of my knowledge and belief, this is a true, correct and complete form:
__________________________________________ _________________________
Signature Date
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signature
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