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Cortland County Office of Budget and Finance 60 Central Ave., Room 132 Cortland, N.Y. 13045 Phone: (607)753-5070 Fax: (607)758-5512 CERTIFICATE OF REGISTRATION Application for authority to collect Hotel, Motel and Bed & Breakfast room occupancy tax Business Name: Location of Business: Mailing Address: (if different than above) Phone: Fax: Email: Cell Phone: Website: On Site Manager: Date business opened in Cortland County: Owner of Record: Federal ID # or Social Security # Type of Establishment: Hotel Motel Bed & Breakfast Other Type of Ownership: Sole Proprietor Partnership Corporation Number of Rooms: Season: I hereby certify that the statements made herein have been examined by me and are to the best of my knowledge and belief is true, correct and complete. Signature Title Type or Print Name Date