Fillable Hotel Tax Waiver Hotel Tax Waiver.pdf (California State University, Chico)

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Hotel Tax Waiver Hotel Tax Waiver.pdf (California State University, Chico)

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ACCOUNTS PAYABLE
Hotel/Motel Transient
KENDALL HALL ROOM 208
CALIFORNIA STATE UNIVERSIT Y CHICO
Occupancy Tax Waiver
CHICO, CA 95929-0243
FINANCIAL SERVICES
530-898-6426
Exemption Certicate
www.csuchico.edu/ap
for State Agencies
Purpose: This form to be completed and retained by hotel/motel operator.
Name:
Address:
City:
State:
ZIP:
STATE AGENCY INFORMATION
This is to certify that I, the undersigned traveler, am a representative or employee of the State agency
indicated below; that the charges for the occupancy at the above establishment on the dates set forth
below have been, or will be paid for by the State of California; and that such charges are incurred in
the performance of my ofcial duties as a representative or employee of the State of California.
Dates of Occupancy:
State Agency and Address: California State University, Chico
400 West First Street
Chico, CA 95929-0243
I hereby declare under penalty of perjury that the foregoing statements are true and correct.
Traveler:
SIGNATURE PRINT NAME DATE
AP: Hotel/Motel Transient Occupancy Tax Waiver Exemption Certicate for State Agencies Updated October 2014
HOTEL/MOTEL INFORMATION
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Hotel Tax Waiver Hotel Tax Waiver.pdf (California State University, Chico)

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Completed 27 July 2020

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