TOWN OF INDEPENDENCE, VA
TRANSIENT OCCUPANCY TAX
FILING FORM
FOR MONTH __________ YEAR ________
1. GROSS RENTAL REVENUE FOR THE MONTH................................. $___________
2. 5% OF GROSS RENTAL REVENUES............................................... $___________
3. AMOUNT RETAINED BY RENTAL AGENT FOR COLLECTION FEE:
Line 2 multiplied by 5%.................................. $___________
4. AMOUNT TO BE REMITTED (Line two minus line three)....................... $___________
FIRM REMITTING TAX: ________________________________________
*DATE REMITTED: __________ SIGNED: ____________________________________
*Tax must be remitted by 20th of each month following collection, in order to retain 5% collection fee.
TOWN OF INDEPENDENCE, VA
TRANSIENT OCCUPANCY TAX
FILING FORM
FOR MONTH __________ YEAR ________
1. GROSS RENTAL REVENUE FOR THE MONTH................................. $___________
2. 5% OF GROSS RENTAL REVENUES............................................... $___________
3. AMOUNT RETAINED BY RENTAL AGENT FOR COLLECTION FEE:
Line 2 multiplied by 5%.................................. $___________
4. AMOUNT TO BE REMITTED (Line two minus line three)....................... $___________
FIRM REMITTING TAX: ________________________________________
*DATE REMITTED: __________ SIGNED: ____________________________________
*Tax must be remitted by 20th of each month following collection, in order to retain 5% collection fee.
TOWN OF INDEPENDENCE, VA
TRANSIENT OCCUPANCY TAX
FILING FORM
FOR MONTH __________ YEAR ________
1. GROSS RENTAL REVENUE FOR THE MONTH................................. $___________
2. 5% OF GROSS RENTAL REVENUES............................................... $___________
3. AMOUNT RETAINED BY RENTAL AGENT FOR COLLECTION FEE:
Line 2 multiplied by 5%.................................. $___________
4. AMOUNT TO BE REMITTED (Line two minus line three)....................... $___________
FIRM REMITTING TAX: ________________________________________
*DATE REMITTED: __________ SIGNED: ____________________________________
*Tax must be remitted by 20th of each month following collection, in order to retain 5% collection fee.
(1996 Code, § 148-Att-A)