Form Cas-Rm-100 - New Jersey Casino Hotel Room Fee Return

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NEW JERSEY CASINO HOTEL ROOM FEE RETURN
CAS-RM-100
(9/03)
Pursuant to P.L. 2003, c.116
FOR THE QUARTER ENDED:
This return and payment must be received no later than the 20th day of the month following the end of the quarter.
Taxpayer Identification Number
FOR DIVISION USE ONLY
-
-
/
Taxpayer Name
Address
City
State
Zip
1. Total Number of Occupied Hotel Room Nights . . . . . . . . . . . . . . . . . . .
1.
3.00
2. Hotel Room Fee Per Night . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2.
X
$
3. Hotel Room Fee Due (Line 1 multiplied by Line 2) . . . . . . . . . . . . . . . .
3.
$
4. Penalty and Interest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4.
$
5. Total Amount Due . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5.
$
This form and payment to the Casino Revenue Fund must be submitted no later than the 20th day
following the quarter for which the fee is due to the following address:
NJ Division of Taxation
Revenue Processing Center
PO Box 254
Trenton, NJ 08646-0254
Under penalties of perjury, I declare that I have examined the above information on the New Jersey Casino Hotel
Room Fee Return and to the best of my knowledge and belief, the information contained herein is accurate.
Date
Signature
Title of Officer

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