TRANSIENT OCCUPANCY TAX & TOURISM IMPROVEMENT DISTRICT RETURN
ESTABLISHMENT:
MAIL ADDRESS:
CERTIFICATE #
PERIOD:
CITY/STATE/ZIP:
INSTRUCTIONS
If there is no tax, a return must still be filed quarterly with the Tax Collector. An envelope is
enclosed for your convenience.
Return is delinquent the 30th day of the month following the close of the reporting period. Change
of address or ownership must be reported immediately to the Tax Collector. Upon cessation of business
for any reason, returns and payments are due immediately to the Tax Collector.
Return this form with your check payable to: Lake County Tax Collector
Checks, drafts, postal notes and money orders
/in the exact amount of tax due, are accepted by the tax
collector subject to collections and do not constitute payment until cleared. Tax Collector assumes no
responsibility for loss in transit or delay in deposit. The cancelled check becomes the receipt.
1 GROSS
RENT FOR OCCUPANCY OF ROOMS/CAMPGROUNDS $
2 RENT FOR OCCUPANCIES GREATER THAN 30 CONSECUTIVE DAYS $
3 TAXABLE RENTS: LINE 1 MINUS LINE 2 $
4 TRANSIENT OCCUPANCY TAX: 9% OF LINE 3 $
5 TOURISM IMPROVEMENT DISTRICT ASSESSMENT: 1.5% OF LINE 3 $
6 TOTAL TAX & ASSESSMENT: LINES 4 + 5 $
7 PENALTY: 10% OF LINE 6 IF PAID WITHIN 30 DAYS AFTER DELINQUENT DATE:
20%OF LINE 6 IF PAID MORE THAN 30 DAYS AFTER DELINQUENT DATE.
$
8 INTEREST: 1/2% OF LINE 6 FOR EACH MONTH OR FRACTION OF MONTH
AFTER DELINQUENT DATE.(NUMBER OF MONTHS: ___ )
$
9 TOTAL TAX/ASSESSMENT/PENALTY/AND INTEREST: LINES 6 + 7 + 8 $
I DECLARE UNDER PENALTY OF MAKING A FALSE STATEMENT THAT TO THE BEST OF MY KNOWLEDGE
AND BELIEF THE STATEMENTS HEREIN ARE CORRECT AND TRUE.
SIGNED____________________________________________________________________________________
TITLE _____________________________________________________________DATE ___________________
Department of the Treasurer - Tax Collector
Courthouse - 255 N. Forbes Street
Lakeport, California 95453
Telephone 707/263-2234
BARBARA C. RINGEN
Treasurer - Tax Collector
ELI
ZABETH MARTINEZ
Assistant Treasurer – Tax Collector
Retain a copy for your records.
