CITY OF FRESNO/CITY OF CLOVIS
TOURISM BUSINESS IMPROVEMENT DISTRICT
TRANSIENT OCCUPANCY CERTIFICATE NO.
Hotel Name
Address City Zip Code
Report Period From: To:
INSTRUCTIONS
1. COMPLETE this entire form (if no assessment is due, fill in spaces with zeros).
RETURN ORIGINAL COPY ONLY TO YOUR SPECIFIC JURISDICTION.
2. Make CHECK or MONEY ORDER payable to, and mail to:
Clovis Hotels: City of Clovis TBID Fresno Hotels: City of Fresno
1033 Fifth Street 2600 Fresno Street
Clovis, CA 93612 Room 2157 TBID
Fresno, CA 93721
3. SIGN AND DATE THIS FORM
REPORTABLE TRANSACTIONS
1. TOTAL RECEIPTS from room rentals $
2. EXEMPTIONS $
(stays: of more than 30 days OR by Railroad and
Airline Crews OR by Tax-exempt Government Employees
on Government business OR per Pre-Bookings/Contracts
executed before January 1, 2011)
3. ASSESSMENT receipts (Line 1 minus Line 2) $
4. TBID ASSESSMENT $
(1.5% of Line 3)
5. 1st Month Delinquent 10% of Line 4 plus 1% Interest $
6. 2nd Month Delinquent 10% of Line 4 plus 1% interest $
7. TBID TOTAL $
Add lines 4, 5 & 6
N O T I C E
Assessment will be delinquent if not paid on or before the last day of the month in which due (Jan, Apr, Jul & Oct).
Assessment may, however, be paid monthly.
A penalty of 10% will be added after the delinquent date. Interest at a rate of 1 % per month or fraction thereof on the
amount of assessment, shall begin to accrue (compound) on the first day of the calendar month after the assessment
becomes delinquent. For clarification, please refer to City of Fresno Resolution No. 2014-177.
C E R T I F I C A T E
I certify that the foregoing statement is true and correct:
SIGNED: TITLE:
Executed at On , 20
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