HOTEL ROOM OCCUPANCY TAX RETURN
FOR USE BY OPERATORS AND ROOM REMARKETERS
-HTX
Period beginning ________-_________-________ Period ending ________-_________-________
Legal Name: Name EMPLOYER IDENTIFICATION
____________________________________________________________________________Change n NUMBER:
Trade Name: OR
____________________________________________________________________________ SOCIAL SECURITY
In Care of: NUMBER:
____________________________________________________________________________
Location Address (number and street): Address
____________________________________________________________________________Change n ACCOUNT
City and State: Zip Code: Country (if not US): ID:
____________________________________________________________________________ FEDERAL BUSINESS
Business Telephone Number: Taxpayer’s Email Address:
CODE:
*40012191* Check type of business entity: n Corporation n Partnership or LLC n Individual, estate or trust
n Initial return: Date business began nn nn nnnn - - n Final return: Date business ended nn nn nnnn - -
(Check this box if you have ceased operations in NYC)
n Amended return Room Remarketers please check box n Enter 2‑character special condition code, if applicable. (See inst.): nn
Operators must enter the following information in order for this return to be complete:
a. If this is a final return, check the "final return" box above and, if there is a new operator, please enter the new
operator’s name, otherwise, enter “None”: ............................................................................................................................................................................................. a.
b. Number of rooms available to transient occupants at the above hotel (see instructions)................................................................ b.
c. Number of rooms rented to permanent residents at the above hotel (see instructions) ..................................................................................... c.
d. If you are an operator renting out apartments or living units under a single certificate of authority in more than one building, check this box and attach an addendum: d. n
e. Billing address, if different
from the address above ):___________________________________________________________________________________________________________________NUMBER AND STREET CITY STATE ZIP CODE COUNTRY
SCHEDULE A Computation of Tax Payment Amount
A. Payment Amount being paid electronically with this return............................................................ A.
RENT CATEGORIES TAX RATE NUMBER OF TAXABLE ROOM RENTALS TAX DUE
(SEE INSTRUCTIONS ) (PER ROOM AND DAY ) DURING THIS TAXABLE PERIOD (TAX RATE X # OF TAXABLE ROOM RENTALS )
1. $ 10 - $19.99............................................................. $ 0.50 1.
2. $ 20.00 - $29.99.................................................... $ 1.00 2.
3. $ 30.00 - $39.99.................................................... $ 1.50 3.
4. $ 40.00 and over .................................................. $ 2.00 4.
ADDITIONAL TAX DUE TAX RATE TOTAL RENTS DURING THIS TAX PERIOD ADD’ L TAX DUE (TAX RATE X TOTAL RENTS )
5. Additional Tax 5.875% 5.
6. Total of lines 1 through 5 ...................................................................................................................................................................................................................................................... 6.
7. Total tax collected (see instructions) ................................................................................................................................................................................................................. 7.
8. Tax before refunds and/or credits (greater of lines 6 or 7) .............................................................................................................. 8.
9. Refunds and/or credits (attach schedule) (see instructions) ........................................................................................................... 9.
10. Total tax due (line 8 less line 9)....................................................................................................................................................................................... 10.
11. Less: (a) Prepayments for the period .............................................. 11a.
(b) Credits carried from previous tax return ............ 11b.
12. Total of lines 11a and 11b ..................................................................................................................................................................................................... 12.
13. Balance due (line 10 less line 12) ............................................................................................................................................................................... 13.
14. Overpayment (line 12 less line 10) ............................................................................................................................................................................ 14.
15. Amount of line 14 to be: (a) Refunded ................................................................................................................................................................ 15a.
(b) Credited to next quarter’s tax ......................................................................................................... 15b.
16. Interest (see instructions) ....................................................................................................................................................................................................... 16.
17. Penalty (see instructions) ....................................................................................................................................................................................................... 17.
18. TOTAL REMITTANCE DUE (line 13 plus lines 16 and 17) .................................................................................................................. 18.
I hereby certify that this return, including any accompanying schedules or statements, has been examined by me and is, to the best of my knowledge and belief, true, correct and complete. Firm’s Email Address:
I authorize the Dept. of Finance to discuss this return with the preparer listed below. (see instructions) .....................................YES n __________________________________________
Preparer’s Social Security Number
_________________________________________ _____________________ __________________ ________________
Signature of owner, partner or corporate officer Title Telephone Number Date
_________________________________________ __________________________________ ________________
Preparer’s signature Preparer’s printed name Date Firm’s Employer Identification Number
CERTIFICATION OF TAXPAYER _____________________________ __________________________________ ______________ Check the box
Firm’s name Address Zip Code Self-Employed: n
MAKE REMITTANCE PAYABLE TO THE ORDER OF NYC DEPARTMENT OF FINANCE. PAYMENT MUST BE MADE IN U.S. DOLLARS, DRAWN ON A U.S. BANK.
ALL RETURNS EXCEPT REFUND RETURNS REMITTANCES RETURNS CLAIMING REFUNDS
NYC DEPARTMENT OF FINANCE PAY ONLINE WITH FORM NYC-200V AT NYC.GOV/ESERVICES NYC DEPARTMENT OF FINANCE
HOTEL TAX OR HOTEL TAX
P.O. BOX 5564 Mail Payment and Form NYC-200V ONLY to: P.O. BOX 5563
BINGHAMTON, NY 13902-5564 NYC DEPARTMENT OF FINANCE BINGHAMTON, NY 13902-5563
40012191 P.O. BOX 3933 NYC-HTX 2020
NEW YORK, NY 10008-3933