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Lodging establishment: Address: Manager: Number of rooms: Occupancy rate: County account number: 210 RAILROAD STREET THOMSON, GA 30824 [PHONE REDACTED] HOTEL/MOTEL TAX REPORT FOR MONTH/YEAR: • Gross Rent paid for lodging • Non-Taxable Rent (must equal a plus b below) A. Stays >30 continuous days B. Other non-taxable rent • Net Taxable Rent (subtract Line 2 from Line 1) • Tax of Line 3) • Vendor's Credit (deduct 3% of Line 4, if not delinquent) • Penalty (add 5% of Line 4, or whichever is greater, for every month or fraction thereof Line 4 is delinquent; but not more than 25% or $25.00, whichever is greater) • Interest (add 1% compounded for each month or fraction thereof Line 4 is delinquent) Total Amount Due I declare under penalties prescribed that the information provided in this return is true and correct to the best of my knowledge. Signed Title Month Day Year Please note: You MUST provide a copy of the same month’s Georgia Sales and Use Tax report. Without it, your report is NOT complete, and will be returned to you. This return must be filed by the 20th of the month following the month for which the tax is due to avoid loss of collector’s compensation and payment of penalty and interest. This return is subject to audit.