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1. 2. 3. 4. 5. 6. 7. 8. Pickens County Hotel/Motel Tax REPORT Business Name Address Business Manager’s Name Business Owner’s Name Phone Number Hotel/Motel Tax Report for Calender Month of , 20 Gross $ Rent from Permanent $ Total Taxable Rent (Line 1 Minus Line $ Tax Due of Line $ Collector’s Compensation (Deductible on timely return) of Line $ Penalty (10% of amount $ Interest per month on delinquent $ TOTAL AMOUNT $ Tax Return Filing Instructions: Deadline: Returns must be filed and paid to the Pickens County Board of Commissioners, 1266 East Church Street, Suite 189, Jasper, GA 30143, on or before the 20th day of the month following the reporting month. Late submissions will result in the loss of the collector’s compensation and liability for penalties and interest. Zero Income Reporting: A return must be submitted each month, even if no rental income was received. In such cases, the report should indicate no amount due. Required Attachment: A copy of your Georgia Sales Tax Report for the month being reported must be attached when submitting this form. I certify that this return has been reviewed and is true and complete for the period stated. Signature Date