Quarterly Report - Collections Of Short Term Rental Tax - County Of York, Virginia
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1ANN H. THOMAS
Commissioner of the Revenue
COUNTY OF YORK, VIRGINIA
Post Office Box 189
Yorktown, Virginia 23690-0189
757-890-3383 FAX: 757-890-3380
QUARTERLY REPORT - COLLECTIONS OF SHORT TERM RENTAL TAX
Make Checks Payable:
Treasurer - York County
BUSINESS ID. NO. «I_D_NUMBER»
FOR THE QUARTER ENDING «QUARTER»
«NAME»
«PHYSICAL_ADDRESS»
«TRADE_NAME»
«MAILING_ADDRESS»
«MAILING_ADDRESS1» «ZIP_CODE»
==
__________________________________________________________________________
1. GROSS RECEIPTS FROM ALL RENTALS:
$______________
2. GROSS RECEIPTS FROM SHORT TERM RENTALS:
$______________
3. LESS ALLOWABLE DEDUCTIONS (ATTACH LIST)
$______________
4. BALANCE
(TAXABLE)
(LINE 2 MINUS 3)
$______________
5. 1% TAX ON LINE 4
$______________
6. PENALTY FOR LATE PAYMENT (10% OF LINE 5)($10.00 min)$______________
7. INTEREST @ 10% P.A. ON LINE 5 & 6
$______________
8. TOTAL TAX, PENALTY AND INTEREST:
$
_______________________________________________________
DECLARATION OF SELLER:
I hereby swear or affirm that the amounts listed are true, correct and
complete to the best of my knowledge and belief for the period stated.
SIGNATURE ________________________ DATE OF REPORT _________/_____ 2009
SIGNATURE
MONTH
DAY
INSTRUCTIONS:
Mail original together with REMITTANCE before the 20th of the month following
the quarter being reported to the Commissioner of the Revenue at the above
address.
ORIGINAL
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