CITY OF MARTINSVILLE
SHORT TERM RENTAL TAX QUARTERLY REPORT
LICENSE NO.
Under penalties of Law, the undersigned certifies that this return is true and
accurate to the best of his/her knowledge and belief and is taken from the books
and records of the business for which this return is filed.
QUARTER
BILL NO.
Signature
Title
Date
NAME
TRADE NAME
ADDRESS 1
ADDRESS 2
CITY STATE ZIP
$
1. Total gross receipts from rentals of 92 days or less
2. Total gross receipts from rentals for more than 92 days
3. Total gross receipts from all rentals (Add Line 1 & Line 2)
4. Total EXEMPT rentals
5. Total Taxable Rentals (Line 3 less Line 4)
6. Total Tax Due (1/2% or .005 x Line 5)
7. Penalty -- 10% of the tax past due or the sum of $10, whichever is greater.
Penalties shall be assessed on the first day following the day that
the quarterly return is due.
8. Interest -- 10% per year, on late payments of any taxes due. Interest shall
be assessed on the first day following the day that the tax
payment is due.
$
9. TOTAL DUE
INSTRUCTIONS FOR FILING
th
This return is due on or before the 20
of each of the months of April, July, October and January, reporting the gross receipts
and taxes collected during the preceding quarter. The tax collected is held in trust for the City of Martinsville until it is due and
payable. State statutes and the City of Martinsville Code provide for late payment and late filing penalties. A filing will be
considered timely when the gross receipts are reported and accompanied by remittance by the due date.
Make checks payable to: City of Martinsville Treasurer
Remit report and payment to: Ruth L. Easley, Commissioner of the Revenue
P. O. Box 1222
Martinsville VA 24114-1122
IF FINAL RETURN PLEASE INDICATE: BUSINESS SOLD OR DISCONTINUED ON _____________
Date