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Part C: Declaration of Responsibility

For each hotel location you operate, complete

the appropriate Declaration of Responsibility for your type of ownership.

Business Certificate #: _____________________ Hotel Location ______________________________________________

Sole Proprietorship -Declaration of Responsibility

By signing this application form, I represent and acknowledge that I am the person responsible for the operation of this hotel location. I

am responsible for the collection of the transient occupancy tax from the guests and payment of those tax revenues to the Tax

Collector. I am liable for all applicable penalties including, but not limited to, the failure to collect and transmit the tax, for

underreporting the tax, for failure to transmit the taxes to the Tax Collector, for any misrepresentations contained in this application, or

for any other violations of applicable law regarding the operation of the hotel location. Those penalties may include, but are not

limited to, suspension and/or revocation of the certificate. If any information included on this application should change, I agree to

inform the Tax Collector of those changes within five working days.

I declare under penalties of perjury under the laws of the State of California that the foregoing is true and correct.

Executed this __________ day of _______________________________, 20____, in _____________________________________

______________________________________________________

_______________________________________________________

Signature

Print Your Name

Partnership - Declaration of Responsibility

By signing this application form, I __________________________, general partner of _____________________________ (the

“Partnership”), with full power and authority to bind the Partnership, hereby represent and acknowledge that the Partnership is

responsible for the operation of this hotel location. The Partnership is responsible for the collection of the transient occupancy tax

from the guests and payment of those tax revenues to the Tax Collector. The Partnership is liable for all applicable penalties

including, but not limited to, the failure to collect and transmit the tax, for underreporting the tax, for failure to transmit the taxes to the

Tax Collector, for any misrepresentations contained in this application, or for any other violations of applicable law regard ing the

operation of the hotel location. Those penalties may include, but are not limited to, suspension and/or revocation of the certificate. If

any information included on this application should change, the Partnership agrees to inform the Tax Collector of those changes within

five working days.

I declare under penalties of perjury under the laws of the State of California that the foregoing is true and correct.

Executed this __________ day of ____________________________, 20____, in _______________________________________

______________________________________________________________ , a ______________________________ partnership

Name of Partnership

State of organization

By ___________________________________________ ____________________________________ _______________________________

Signature of Individual

Print Your Name

Title

Corporation - Declaration of Responsibility

By signing this application form, I __________________________, an officer of _____________________________ Corp oration (the

“Corporation”), with full power and authority to bind the Corporation, hereby represent and acknowledge that the Corporation is

responsible for the operation of this hotel location. The Corporation is responsible for the collection of the transient occupancy tax from

the guests and payment of those tax revenues to the Tax Collector. The Corporation is liable for all applicable penalties inc luding, but

not limited to, the failure to collect and transmit the tax, for underreporting the tax, for failure to transmit the taxes to the Tax Collector,

for any misrepresentations contained in this application, or for any other violations of applicable law regarding the operati on of the

hotel location. Those penalties may include, but are not limited to, suspension and/or revocation of the certificate. If any information

included on this application should change, the Corporation agrees to inform the Tax Collector of those changes within five working

days.

I declare under penalties of perjury under the laws of the State of California that the foregoing is true and correct.

Executed this __________ day of _______________________, 20____, in _____________________________________________

___________________________________________________________________ , a __________________________ corporation

Name of Corporation

State of Incorporation

By ___________________________________________ ______________________________________ _______________________________

Signature of Officer

Print Your Name

Title

Hotel COA Application

Page 3 of 3

Rev. 4/11/12

Certificate Of Authority (Coa) Application To Collect Transient Occupancy Tax - San Francisco Office Of The Treasurer & Tax Collector Page 3

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