Name of Business ______________________________________________ Phone __________________________
Business Location ________________________________________________________________________________
Report for the Month of: ______________________________________ Year: _____________________________
I. This report must be filed and the tax paid by the 20
th
day of every month following the month in which the tax
was collected to avoid loss of vendor’s compensation and the assessment of penalties and interest.
II. A copy of corresponding month’s Georgia Department of Revenue sales and use tax report (Form ST-3) must be
attached to this report
III. Section 12 of the City of Dahlonega’s Ordinance 85-2, Amendment 7, provides for allowable exemptions from
the tax.
IV. In the event there is no tax collected under this Ordinance by the Innkeeper for a month, such Innkeeper shall
nevertheless file a return showing a zero (0) as the tax collected for such month.
1. Gross Room Rentals $ ________________________
2. Less Exemptions $________________________
3. Taxable Rentals (Line1 less Line 2) $________________________
4. Tax Due (8% of Line 3) $________________________
5. Less Collection Fee (3% of Line 4, if filed and taxes paid after due date) $ ________________________
6. Total Tax Due (Line 4 less Line 5) $ ________________________
7. Plus Penalty and Interest (In accordance with the City of Dahlonega $ ________________________
Ordinance 85-2, Amendment Number 7, Section 17 and Section 18)
8. Total Tax, Penalty, and Interest (line 6 plus Line 7) $________________________
Under penalty of perjury, I declare that I have examined this document and supporting documentation, and to the best
of my knowledge, information, and belief, they are true, correct, and complete.
_____________________________________________ _______________________________
Signature of Innkeeper Date
Make Checks payable to: City of Dahlonega
CITY OF DAHLONEGA
465 Riley Road
Dahlonega, Georgia 30533
Phone: 706-482-2706 • Fax: 706-864-4837
ACCOMMODATION EXCISE TAX RETURN
