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City of Anaheim Transient Occupancy Tax Return Reporting Period: Please fill in the circle to the left of the reporting month Year: Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec / Name of Hotel: Address: T.O.T. No. of Rooms Rented This Month: $ CASHIER'S VALIDATION ONLY For Overnight/Express Delivery Only Send to: Phone Number I Declare under Penalty of making False Statements, that to the best of my Knowledge and Belief, the Statements herein are Correct and True. Signature of Operator or Agent Name Title Address Date Mail This Copy To: CITY OF ANAHEIM LICENSE COLLECTOR P.O. Box 61042 ANAHEIM, CA 92803-6142 (714) 765-5170 CITY OF ANAHEIM BUSINESS LICENSE DIVISION 200 S. ANAHEIM BLVD., #136 ANAHEIM, CA 92805 NOTICE The Tax will be delinquent if not received by the License Collector on or before the last City Business day of the month in which due. Penalties and interest will be assessed from the 1st day of delinquency. Postmarks are not accepted as payment date. $ $ $ $ $ $ $ $ $ $ 1. ENTER TOTAL GROSS RENTAL RECEIPTS A. ENTER RECEIPTS EXEMPTED FOR OCCUPANCIES OF 30 DAYS OR MORE B. ENTER RECEIPTS EXEMPT UNDER ANAHEIM MUNICIPAL CODE SECTION 2.12.015 C. OTHER ADJUSTMENTS (ATTACH EXPLANATION) 2. ENTER TOTAL OF LINES A+B+C 3. TOTAL TAXABLE RECEIPTS (LINE 1 MINUS LINE 2) 4. TAX - 15% OF LINE 3 5. OVERCOLLECTED TAX 6. PENALTY - 10% PER MONTH OF LINES 4 + 5 7. INTEREST - 1.5% PER MONTH OF LINES 4 + 5 8. TOTAL DUE - TAX PLUS PENALTY & INTEREST (LINES 4+5+6+7) TOT 0.00 0.00 0.00 0.00 ---PAGE BREAK--- CITY OF ANAHEIM TRANSIENT OCCUPANCY TAX INSTRUCTIONS LINE 1. TOTAL GROSS RENTAL RECEIPTS means the consideration charged by an operator for accommodations, including without limitation any unrefunded advance rental deposits or separate charges levied for items or services which are part of such accommodations such as appliances, furniture, linens, towels etc. LINE 1A. Enter RENTAL RECEIPTS for transients that exercise occupancy for longer than 30 days. It also includes transients residing under a “Qualifying Rental Agreement.” LINE 1B. Exemptions are only allowed pursuant to Section 2.12.015 of the Anaheim Municipal Code. If you have specific questions regarding who may be exempt, please contact the City of Anaheim, Business License Division at (714) 765-5170. LINE 1C. Supporting documentation must be included for this adjustment. LINE 2. Add LINES 1A., 1B. and 1C. together and indicate here. LINE 3. Subtract LINE 2 from LINE 1 and indicate here. LINE 4. Multiply LINE 3 by 15 percent and indicate here. LINE 5. Report any receipts that were collected under the representation of tax from the transient and were not required to be collected as tax. LINE 6. The tax is delinquent if it is not received by the License Collector on or before the last City business day of the month in which due. Postmarks are not acceptable as payment date. Penalties are ten percent per month of LINE 4 not to exceed fifty percent of the amount due. LINE 7. In addition to any penalty, any operator who fails to remit any tax within the time specified, shall pay an interest upon such tax of one and one-half percent per month of LINE 4 calculated from the first day of delinquency to the date of payment. LINE 8. Add LINES 4, 5, 6, & 7 and remit a check payable to “City of Anaheim”. Checks are accepted by the License Collector only as agent of the taxpayer and does not constitute payment until cleared. IF BUSINESS IS SOLD OR CLOSED: Returns and payments are due immediately upon cessation of business for any reason. All taxes collected by the operator shall be paid to the License Collector. No change of ownership can be recorded until this is done. A “Transient Occupancy Tax Clearance Certificate” must be obtained from the City License Collector.