Monthly Transient Lodging Tax Report Delinquent Form

Operators submit this form for delinquent reporting.

Monthly Collections must be submitted on or before the 15th of the following month. Penalties/interest will be assessed if not submitted on or before the last day of the following month.

Notify the Finance Department immediately of any changes of disposition or suspension of business.

When submitting printed version, please make checks payable to Clackamas County Finance.

Certificate No.

Period Covered:

Start:

End:

Location Name:

Email:

Second Email (optional)

Address (optional)

City (optional)

State (optional)

Zip (optional)

Has your contact info changed?

Yes

1. Gross Cash Receipts
Net of Bank Credit Card Fees

Exempt Receipts:

A. Monthly Rentals (optional)
More than 30 successive calendar days

B. Rent less than $15.01 per day (optional)

C. U.S. Government Employees on official business (optional)

D. Online Travel Company Gross Receipts (optional)

2. Total Exempt Receipts
Add Lines A through D

3. Taxable Receipts
Line 1 minus Line 2

4. Total Lodging Tax for this Period
6% of Line 3

5. Collection Reimbursement
5% of Line 4

6. Total Tax Due for Month
Line 4 minus Line 5

7. Penalty

A. 10% of Line 6 for first month payment is delinquent

B. 15% of Line 6 for second month payment is delinquent

8. Interest
1% of Line 6

A. Months delinquent

B. Interest per Month

Total Interest

9. Adjustment from Prior Period (optional)

Include reason here

Total amount

I declare that to the best of my knowledge and belief, the statements herein are correct and true.

Clicking "Submit Report" will take you to the US Bank website to make your payment.