QUARTERLY TRANSIENT LODGINGS TAX REPORT
The quarterly report and tax payment are due the 15
th
of the month following the end of the quarter.
Due Dates: 1
st
Quarter – April 15
th
, 2
nd
Quarter – July 15
th
, 3
rd
Quarter – October 15
th
, 4
th
Quarter – January 15
th
Payment must be received or postmarked by the close of business on the following dates to avoid the 10% penalty charge:
1
st
Quarter – April 30
th
, 2
nd
Quarter – July 31
st
, 3
rd
Quarter – October 31
st
, 4
th
Quarter – January 31
st
.
NAME OF F
ACILITY
ADDRESS
TELEPHONE______________________ NO. OF ROOMS__________ PERIOD ENDING___________________
1.
Gross Rental Fees Collected $___________________
2. Monthly rentals $__________________
3. Rent less than $2/Day $__________________
4. Federal Government Contract Lodging $__________________
5. Uncollectables $__________________
6. Transient Lodging Intermediaries (attach Schedule SLT-1) $__________________
7. TOTAL ALLOWABLE DEDUCTIONS (SUM OF LINES 2, 3, 4, 5 & 6) $___________________
8. TAXABLE RENTS (LINE 1 MINUS LINE 7) $___________________
9. Convention Center Surcharge (Line 8 x .025) $__________________
10. Special Convention Center Tax (Line 8 x .03) $__________________
11. Operator’s Collection Fee (Line 9 and 10 x .05) $(_________________)
12. TAX
DUE COUNTY (THE SUM OF LINE 9 PLUS LINE 10 MINUS LINE 11) $___________________
13. TRANSIENT LODGING TAX DUE CITY (LINE 8 X .06)* $___________________
14. Penalty $__________________
15. Interest $__________________
16. Adjustment for Prior Shortage $__________________
17. Adjustment for Prior Overage $__________________
18.
TOTAL ADDITIONS & ADJUSTMENTS (SUMS OF LINES 14, 15, 16, MINUS LINE 17) $___________________
19. TOTAL DUE (LINE 12 PLUS 13 AND 18) $___________________
I declare, under penalty of making a false statement, that to the best of my knowledge and belief, the statements herein are
correct
and true.
SIGNED__________________________________________________________
PRINT NAME_____________________________________ TITLE________________________________________
PLEASE MAKE CHECKS PAYABLE TO: CITY OF WOOD VILLAGE
2055 NE 238
TH
DRIVE
WOOD VILLAGE, OR 97060