JEFFERSON COUNTY, TEXAS HOTEL OCCUPANCY TAX REPORT Eni namber Fg por = Dood 4. Nae and mailing eres (Mate any necessary name changes blow.) IMPORTANT, ‘Back ct this box if ny preprined information fis changed. Show changes ‘by the preprinted infomation, Blackout hs box if ny lesion shown isnofongrin Business, write “COB ‘and the dae you went cut of business ‘ese tht location, 2. Outlet Tae Name and Location Adres 3.Tolal Room} 4. Total Taxable Receips Receips EB 6, Tol exableeeipt For ALL lotions (em 4 from head al supplemental pages) 7. die (296 fem) @$_$$_$_$_$_$__, 8, Penalty (Se insretions) 9. noes Se instrctions) = 10. TOTAL AMOUNT DUB AND PAYABLE Ue 7 pits em 8 an lem 9) + [—___| 7 alr tha ie nero i is doeumient and ey Wahnente we Te snd comet fo the best of my- knowledge and el ‘ally Auorand Agent ‘Waka wnount nom 10 payaio JEFF. CO. TAX AVC alo: Teer County Tax Offer is P.O, Box 2112 baa » Heron, Yeas 7704 here Forasisanoe call! 409-835-8516 Dastine pre Date Forms for reporting Flotel Occupancy Tax will be mailed before each monthiy payment is due, Payments are due on the 20% day of the month following the reporting period. ‘This report must be returned under any condition, **Payment with a check authorizes us to convert your check to an Electronic Fund 'Transfer**INSTRUCTIONS FOR COMPLETING THE COUNTY HOTEL OCCUPANCY TAX REPORT GENERAL INFORMATION WHO MUST FILE: WHEN TO FILE; GENERAL INSTRUCTIONS: * You mast file this ream if you are a sole owner, panneshp, corporatia cr oer organization dit ons, opts, manages or conto any ote ot metal a Jeferson County, Texas "Compete and detailed records must be thet retus canbe veriied by the kop of all eselpts reported and exemptions ot reimbursements claimed 50 Coumy audit. "Failure toile his eur and pay epplicale tx nay result in collection actin, ‘*Returss mut be filed on or before tne 20* day ofthe anonth following he reporting period, ‘RETURNS MUST BE LEO FOR EVERY PERIOD EVEN IF YOU HAVENO AMOUNT SUBIECT T0 TAX OR NO TAX DUE, "Eth due dts fas on a Sotarday, Sunday or legal County holiday, the neat bsness day wil eth due ae, ‘nvr on pt *Coraplete al applicable items tha are uot preite, "if say preprinted information snot comec, mark tout and wrt nthe cect infoason, SPECIFIC INSTRUCTION tem 1 & 2 Eater the location capacity, ade name, location alters em 3 tient tems Cetin cy, state an 2? coe) operation, write "OO" andthe d ‘any ocacin has eased ‘pertin ceased for tat Ener de ota amount of 90m reels fr the oer: stows, Enter “O" ifm receipes were collated, Eater the amount of TAXABLE receipts fort Shown, Enter"O” ifno table ecepts were cllesed. Enter the combined total of al! total oom receipts shown ia tem 3 ofthis repr forthe repening period, Est "Oi. ng egeipts were collected for this reporting pia. em 6 tems emg Enter the combined tot of al taxable aor receipt shown in lem 4 ofthis repor forthe reporting period, Extet “0” ina ‘ble receots were coll fr this porting period, Benaly « IF REPORT 18 FILED OR TAX PAID AFTER ‘THE DUE DATE, the owner shall pay » penalty of 3% of the ‘mount of the tax due, If te owner fist file the repert or ‘ay the tax bere the 31% day eer the due dt, an sional pensly of of the amount du shel be paid Delinguent axes and accrued penalties draw interest tthe rate of 10%6 a yea Beginning 60 days afer the die on which the tacwas die