Lodging Monthly Remittance Form

Report for the month of:
Year
Name of Business*
Telephone Number*
Email Address*
Business Address*
Street Address Address Line 2 City State ZIP Code
Physical Address
Same as Business Address

Street Address Address Line 2 City State ZIP Code
Lodging Charges subject to tax
Tax on Lodging (8%)
Total tax due by the 20th (Make check payable to Town Treasurer)
Due no later than the 20th. Late fee applies on the 21st
Total tax due ONLY IF paying after the 20th. Penalty included. (Make check payable to Town Treasurer)
OR
Basic License Fee = $30.00
I hereby swear or affirm that the amounts listed above are true, correct and complete to the best of my knowledge and belief for the period stated above.
Sign Here*
First Last
Consent*
I agree to electronically sign and to create a legally binding document between the other party and myself, or the entity I am authorized to represent.*

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