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CITY OF ANAHEIM TRANSIENT OCCUPANCY TAX Planning Department ■ Business License Division (714) 765-5170 SPECIAL PACKAGE FORM Office Use Only: Package Return this form for processing to: City of Anaheim, License Collector P.O. Box 61042, 200 S. Anaheim Blvd., Anaheim, CA 92803-6142 PLEASE PRINT OR TYPE TOT Hotel or Motel Name: Hotel or Motel Address: Contact Person: Phone Name of Package: Effective Dates: # of Persons: DESCRIPTION TOTAL AMOUNT OF EACH ITEM # of Nights: Rate Transient Occupancy Tax 15% ATID Assessment 2% (if applicable)___________ Package Elements * a. b. c. d. e. f. g. h. TOTAL SPECIAL PACKAGE RATE *Package elements must be accompanied by documentation to substantiate fair market value. The total package price may change by no greater than 10%. If total package price changes in excess of 10%, a new package must be submitted. THE USE OF THIS PACKAGE PRIOR TO APPROVAL IS DONE AT YOUR OWN RISK DO NOT WRITE BELOW THIS LINE Date Received: Cashier’s Validation: Approved by: Date Approved: Denied/Returned Date Resubmitted Filing Fee: $ 25.00 1102-6T ---PAGE BREAK--- INSTRUCTIONS FOR SPECIAL PACKAGE FORM PACKAGE# The number assigned by the License Collector. NAME OF HOTEL Name of Hotel/Motel as indicated on the City Business License. TOT # Number assigned to Hotel by License Collector as indicated on the Transient Occupancy Tax Return Form. ADDRESS Physical Location of Hotel/Motel CONTACT PERSON Name of Individual that the License Collector can contact concerning Special Package Form. PHONE NUMBER Phone Number at which the Contact Person can be reached. NAME OF PACKAGE Name assigned by Hotel/Motel. EFFECTIVE DATES Dates for which the package is planned for use. A start date must be shown. ROOM RATE The consideration charged for the accommodations portion of the Special Package. TOT TAX Transient Occupancy Tax at the rate of 15% of the Room Rate. ATID ASSESSMENT Anaheim Tourism Improve District Assessment at the rate of 2% of the Room Rate for the hotel properties that are within the ATID boundaries. PACKAGE ELEMENTS This area to be used to itemize all items offered as part of a Special Package including the amount charged for the listed item. The operator must submit documentation to substantiate the claimed fair market value of each item listed excluding the Room Rate, Anaheim TOT and ATID (if applicable). TOTAL SPECIAL PACKAGE RATE The Sum of each item listed within the Package Elements plus Room Rate, Anaheim TOT and ATID (if applicable). THE TOTAL PACKAGE PRICE MAY CHANGE BY NO GREATER THAN 10%. IF THE TOTAL PACKAGE PRICE CHANGES IN EXCESS OF 10%, A NEW PACKAGE MUST BE SUBMITTED.