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Hotel/Motel Tax Report Form Pickens County Hotel/Motel Tax – Report Business Information Report for Calendar Month of , Tax Calculation 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. Business Name: Address: Business Manager’s Name: Business Owner’s Name: Phone Number: Description Amount (USD) 1. Gross Rent 2. Rent from Permanent Resident(s) 3. Total Taxable Rent (Line 1 minus Line 2) 4. Tax Due of Line 3) 5. Collector’s Compensation of Line 4 if timely filed) 6. Penalty (10% of amount due) 7. Interest per month on delinquent taxes) 8. TOTAL AMOUNT DUE ---PAGE BREAK--- Required Attachment: A copy of your Georgia Sales Tax Report for the month being reported must be attached when submitting this form. Certification I certify that this return has been reviewed and is true and complete for the period stated. Signature: Date: