Transient Occupancy Tax
Monthly Report
Report for the month of 20 .
Name:
Trading As:
Contact Person:
Address:
Phone Number:
E-Mail:
Tax on Lodging
1. Gross Receipts from Lodging and/or campsites $
2. Tax Due (4% of Line 1) $
3. Owner Commission (5% of Line 2) $
4. Penalties (Late Filing 5%) $
5. Add'l 5% Penalty Imposed for each 30 day period $
6. Total Due $
I hereby certify that this report is true and accurate to the best of my knowledge and belief, and herewith transmitted on this date payable to Bath County Treasurer in the amount of $ representing the total amount of Transient Occupancy Tax Collection by our firm for the month of .
Digital Signature:
Report is due on or before the 20th day of the following calendar month.