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Mailing Address PO Box 8000, Leesburg, VA 20177-9804 In-person Service Leesburg - 1 Harrison Street SE, 1st Floor Sterling - 46000 Center Oak Plaza Robert S. Wertz, Jr. Web loudoun.gov/COR Phone [PHONE REDACTED] Residential Rental Property List Owner Information Individual/Business Name Account # Phone Email Property Information Parcel Identification Number (PIN) Tenant Name Physical Address Street City Zip Property Sold? [ ] No [ ] Yes If yes, date sold New Owner Parcel Identification Number (PIN) Tenant Name Physical Address Street City Zip Property Sold? [ ] No [ ] Yes If yes, date sold New Owner Parcel Identification Number (PIN) Tenant Name Physical Address Street City Zip Property Sold? [ ] No [ ] Yes If yes, date sold New Owner Parcel Identification Number (PIN) Tenant Name Physical Address Street City Zip Property Sold? [ ] No [ ] Yes If yes, date sold New Owner Parcel Identification Number (PIN) Tenant Name Physical Address Street City Zip Property Sold? [ ] No [ ] Yes If yes, date sold New Owner Certification I declare that this information is true, complete, and correct to the best of my knowledge and belief. Owner/Agent Signature Date Signed 1 I BTA13-1025 SIGN ---PAGE BREAK--- Residential Rental Property List General Information Use this form to supply a list of residential long-term rental properties located in Loudoun County with your Business License Return. Virginia law 58.1-3700) permits local governments to impose a tax on gross rents. Loudoun County ordinance chapter 840.14(l) requires owners of three or more residential dwelling units which are rented long-term to register for a Rental by Owner (RBO) business license and pay a tax annually. According to Virginia law, long-term rental properties are those rented for 30 or more days in a term. Rentals provided for a term of less than 30 days are taxed as lodging establishments. Review relevant info at: loudoun.gov/BusinessTax. You can find online forms at loudoun.gov/COR-Forms. Need help? Staff assistance is available Monday through Friday, during County business hours. To reduce your wait time, we encourage scheduling an appointment. We are open 8:30 AM to 5:00 PM in: Leesburg 1 Harrison St. SE, 1st Floor Sterling 46000 Center Oak Plaza For assistance with a specific topic, email or call: Business Tax Assessment [EMAIL REDACTED] [PHONE REDACTED], option 2 Business Tax Compliance [EMAIL REDACTED] [PHONE REDACTED] Accommodations: If you require a reasonable accommodation for any type of disability or need language assistance in order to access this form, please contact [EMAIL REDACTED]. Three business days advance notice is requested. Privacy: This Office protects records according to applicable Virginia statutes and U.S. federal laws. Any personal information we collect and maintain is retained in compliance with statute. Instructions 1. Owner Information - Provide the name of the individual or business owner of the properties, along with their business tax account number, daytime phone number, and email address. 2. Property Information - Provide the information requested for each residential long-term rental property. For additional properties, include the same information on an additional page. 3. Certification - Read, sign, and date the certification. 4. Submit this form in-person at one of the locations listed above or: Upload it to: loudoun.gov/COR-Upload Mail it to: COR - Business Tax Assessment PO Box 8000, Leesburg, VA 20177-9804 Find webforms at: loudoun.gov/COR-Forms 2 I Loudoun County I Office of the Commissioner of the Revenue I BTA13-1025