APPENDIX A: HOTEL/MOTEL TAX RETURN

PERIOD COVERED

VILLAGE OF SHILOH

HOTEL/MOTEL TAX RETURN

Name of hotel or motel a

Name of operator b

Address of hotel or motel location c

Receipts for the period covered by the return as a total for the period and for each month covered by the period

d

Receipts attributable to permanent residents by month and as a total for the period e

The difference between d and e above for each month and for the period f

The tax collected for the period g

The tax paid with the return for the period h

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I confirm that to the best of my knowledge this return is true and accurate and the tax due and owing for the period is correct as shown on this return.

Operator or Agent

Commission Expires:

 

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