TOWN OF DAMASCUS
Telephone: 276-475-3831
MONTHLY REPORT OF LODGING AND/OR MEALS TAX
FOR THE MONTH OF ___________________, 20______
:________________________________________________________
NAME OF BUSINESS
:_________________________________________________________
MAILING ADDRESS
___________________________________
TELEPHONE NUMBER OF BUSINESS:
HOME ADDRESS OF OWNER: *
_________________________________________________
HOME TELEPHONE NUMBER OF OWNER: *______________________________________________
1. Lodging and/or Meals charges subject to Tax
$
2. Tax on lodging and/or meals (5% of line 1)
$
3. Subtract 4% collection fee from line 2
$
DO NOT subtract collection fee if paying after due date.
TOTAL TAX DUE: (line 2 minus line 3)
$
PENALTY (10% OF TAX DUE)
$
Total due if paid after due date
$
PENALTY APPLIES IF PAID AFTER THE LAST DAY OF THE MONTH FOLLOWING MONTH
BEING REPORTED
SIGNATURE OF BUSINESS REPRESENTATIVE:
_____________________________________________________
PLEASE MAKE CHECK PAYABLE TO:
TOWN OF DAMASCUS and mail to:
PO Box 576,
Damascus, VA 24236-0576
DATE RECEIVED BY TREASURER’S OFFICE_______________________________________
*Home address and telephone number of owner is needed in case of an emergency at times the business is not
open.
FORM MUST BE FILED EVERY MONTH. IF NO MONIES ARE RECEIVED, A FORM
SHOULD STILL BE FILED SHOWING “ZERO” DUE.
Town Of Damascus, PO Box 576, Damascus VA 24236, (276) 475 3831
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