Fillable Jane Haskins, Deputy Finance Elizabethtown, NY 12932 (Monroe-Woodbury Central School District)

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Jane Haskins, Deputy Finance Elizabethtown, NY 12932 (Monroe-Woodbury Central School District)

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Michael G. Diskin, Treasurer Essex County Government Center Phone: 518-873-3310
Lisa Decker, Deputy – Taxes 7551 Court Street P.O. Box 217 Fax: 518-873-3318
Jane Haskins, Deputy – Finance Elizabethtown, NY 12932
E-mail: Michael.Diskin@essexcountyny.gov
INSTRUCTIONS FOR ROOM TAX RETURN FORM
PAYER # will be assigned by the Essex County Treasurer’s Office. If you are a First Time Registrant, the
Treasurer’s Office will notify you of your PAYER # once it is assigned to you.
1. Please type or print the name of the business OR
2. Please type or print the name of the Owner and Telephone # of the Owner
3. Mailing Address of the Business/Owner
4. Contact Information and Title, if different than information above
5. Telephone #, if different than information above
6. Please choose the Reporting Period for which you are submitting payment
7. A. Revenue from Traditional Hotel/Motels Stays should be reported here
B. Revenue from Vacation Rental Unit Stays should be reported here
8. Report any Sales exempt from NYS Sales and Use Tax
9. Net Revenue Line A. + Line B. – Line 8
10. Room Occupancy Tax Owed = 5% of Net Revenue (for all stays/bookings on or after 6/1/2020)
11. A Penalty of 5% is charged on all taxes due that are not paid or postmarked by the 20
th
day of the
month the taxes are due – i.e. if a tax is due by 3/20, but not paid or postmarked by 3/20, but instead
sent after that date, a penalty of 5% of the amount reported on Line 10 is owed.
12. Interest of 1% per month is charged as an additional penalty if payment is made more than 30 days
after the end of the period being paid – i.e. a tax period ends on 2/28 and payment for this period is
due by 3/20. If payment is not made until after 3/30, 1% interest ids due. Interest continues to
accumulate for each month or fraction thereof for each month the payment is late until it is paid. There
is no interest charged in the first 30 days of the end of the period.
13. The TOTAL AMOUNT DUE is Line 10 + Line 11 + Line 12
OFFICE OF THE ESSEX COUNTY TREASURER
ESSEX COUNTY TREASURER
P. O. BOX 217 7551 COURT STREET
ELIZABETHTOWN, NY 12932
TEL: 518-873-3310 FAX: 518-873-3318
WEBSITE: www.co.essex.ny.us
ESSEX COUNTY ROOM OCCUPANCY TAX RETURN FORM
PLEASE PRINT OR TYPE PAYER # ________________
1. Business Name: _______________________________________________________________
2. Owner Name: _______________________________ Tel. # ______________________________
3. Mailing Address: ________________________________________________________________
4. Contact Name: ________________________________ Title: _____________________________
5. Tel. # ____________________________________
6. FILING PERIOD (CHOOSE ONE)
Annual: 3/1 – 2/28 __ Quarterly: 12/1-2/28 __ 3/1-5/31__ 6/1-8/31 __ 9/1-11/30 __ Monthly: _____
DUE DATE by 3/20 by 3/20 by 6/20 by 9/20 by 12/20 by 20
th
of
following month
Computation of Taxes Owed
7. A. Revenue from Traditional Hotel/Motel Stays $_____________________________
B. Revenue from Vacation Rental Units (6410 41133) $_____________________________
8. Less Tax Exempt Sales $_____________________________
9. Net Revenue (Line 7A. + Line 7B. – Line 8) $ ____________________________
10. ROOM OCCUPANCY TAX DUE (5% OF LINE 9) $_____________________________
11. PENALTY (5% of Line 10 if not paid within 20 days of the end of the reporting period) $_____________________________
12. INTEREST (1% of Line 10 for each month or fraction there of if tax is not paid $_____________________________
within30 days of the period covered by the return – no interest on first 30 days)
13. TOTAL AMOUNT DUE (Line 10 + Line 11 + Line 12) $_____________________________
Under the penalties of perjury, I hereby certify that the statement made herein have been examined by me,
and are, to the best of my knowledge and belief, true, correct, and complete.
DATE: __________________ NAME: _____________________________________________
MAKE PAYMENT PAYABLE TO “ESSEX COUNTY TREASURER” AND MAIL IT WITH THIS RETURN TO:
Essex County Treasurer’s Office
P.O. Box 217
7551 Court Street
Elizabethtown, NY 12932
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Jane Haskins, Deputy Finance Elizabethtown, NY 12932 (Monroe-Woodbury Central School District)

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Completed 15 April 2021

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