HAMILTON COUNTY TRUSTEE
REQUEST FOR REFUNDS FOR NON-TRANSIENT TENANTS
HOTEL/MOTEL NAME: ________________________ DATE: ____________________
ADDRESS: ___________________________________ HOTEL NUMBER: __________
Name of Non- Date for Qualifying Rent Charged and Rent Charged and Assessed Occupancy Tax Charged for
I hearby certify that the above is a true and correct statement, ________________________
(Taxpayer’s Signature)
(Internal Use Only)
The above claim for refund is approved in the amount of $__________ __________________
(Approved by)
________________
Date
____________________
Check number
Taxpayer instructions: Complete this form to request a refund for any occupancy taxes charged, collected, and remitted to the
Hamilton County Trustee from Non-Transient tenants (defined as a persons who exercise Occupancy or an entitled to Occupancy
for any room, lodging or accommodations in a HOTEL for a period of more than 90 days for COUNTY purposes and more than
30 days for CITY purposes).
List any tenants above from whom you have collected occupancy taxes who have reached Non-Transient status. List the
applicable dates in which they have been charged taxes, the rent during the period they have been charged occupancy taxes, and
the amount of occupancy taxes that you are requesting for refund. Note that the HOTEL is required to remit any applicable
refunds from this request to the associated Tenant or apply the refund to the Tenant’s account.
Mail completed form to: Hamilton County Trustee; 625 Georgia Avenue, Room 210; Chattanooga, TN 37402
