Form 150-604-002-3 - Oregon Lodging Tax Quarterly Return - 2012

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Oregon Lodging Tax
FOR OFFICE USE ONLY
Date received
•
Quarterly Return
Payment received
Tax Year 2012
•
3
Quarter
Due date
Program code
Year
Period
Liability
*
Business identification number (BIN)
07/01/12 to 09/30/12 October 31, 2012
•
•
•
•
525
12
09
1
STOP!
Federal employer identification number (FEIN)
RequiRed Field See instructions.
3rd Quarter
*
RequiRed Field
Mailing address:
Amended return?
Yes
*
Name
Mailing address change?
Yes
Physical site address:
*
*
Address
Address
*
*
*
*
*
*
City
State
ZIP code
City
State
ZIP code
See instructions on separate page.
A. Has ownership changed since the last reporting period?
Yes
No
B. Is this your final return because you closed or sold this business?
Yes
No
Date business was
bought
sold
closed: ____________________New owner/operator name: __________________________
(
)
New owner’s telephone number: _____________________
C. Number of taxable rental properties .......................
Note: If you are reporting taxable lodging sales from multiple vacation rental properties under this BIN and if you have changes from the last reporting period, you
MUST provide us with a current list of each of your rental properties. Please include the physical address of each property. Attach the list to this return.
D. Number of taxable units/sites available for rent .....
E. Number of units/sites rented during the quarter ....
•
1. Total gross receipts for lodging sales ................................................................................................... 1
2. Nontaxable lodging sales.
See instructions.
STOP!
2a. Long-term or monthly rentals ............................................................ 2a
0.00
2b. Federal employees on business ........................................................ 2b
0.00
2c. Federal instrumentalities ................................................................... 2c
0.00
•
2d. Nontaxable lodging sales TOTAL (add lines 2a thru 2c) ................................................................ 2d
0.00
3. Total taxable lodging sales (subtract line 2d from line 1) .................................................................... 3
4. Tax rate ................................................................................................................................................... 4
x 0.01
5. Tax due (multiply line 3 by line 4) ........................................................................................................... 5
x 0.05
6. Administrative fee rate ............................................................................................................................ 6
(
)
7. Administrative fee (multiply line 5 by line 6) This will reduce your tax ................................................... 7
•
8. TOTAL TAX DUE (subtract line 7 from line 5) ........................................................................................ 8
$
FINISHED? PRINT NOW for mailing. Your return can’t be submitted electronically or saved to your computer.
Under penalty of false swearing, I declare that the information in this return and any attachments is true, correct, and complete.
Signature
Date
PRINT name signed above
Title
Telephone number
(
)
Mail this return on or before the due date shown above to: Oregon Lodging Tax
Oregon Department of Revenue
Keep a copy for your records
PO Box 14110
Salem OR 97309-0910
150-604-002-3 (Rev. 03-12)

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