Form Ctca 047 PDF Details

Every small business owner knows the importance of customer service. The customer is always right, and you have to do whatever it takes to make them happy. When it comes to cancer care, the patient is always right. That's why at Connecticut Cancer Care (Ctca), we place such a strong emphasis on our patients' needs and wants. Our Patient Navigation team goes above and beyond to ensure that each and every one of our patients feels comfortable and informed about their care. We want our patients to feel like they are part of the Ctca family, and we are committed to providing them with the best possible care. If you or someone you know is looking for cancer care, please visit us online or call us today! We would be happy to answer any questions you may have. Thank you for considering Ctca as your trusted cancer care provider!

QuestionAnswer
Form NameForm Ctca 047
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesBIL, III, CTCA, Subchapter

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TOUR8SM 1SS4SSM4NT 5ORM

/

 

58L4 ON4 5ORM 5OR 4137 LO31T8ON

Section 8. 2usiness Location 8nfor)ation

Section 88.

Parent or 2i((ing 8nfor)ation

2usiness )ust have a sing(e 548N nu)ber New 2usiness Location

Section app(icab(e on(y to parent co)panies Sa)e as 2usiness Location

Touris) 8D #:

 

28L 8D #:

 

2usiness Na)e:

 

2i((ing Na)e:

 

2usiness 1ddress:

 

2i((ing 1ddress:

3ity, State, Zip:

 

3ity, State, Z8P:

3ontact Na)e:

 

3ontact Na)e:

3ontact Tit(e:

 

3ontact Tit(e:

 

Phone nu)ber:

 

Phone nu)ber:

 

5ax nu)ber:

 

5ax nu)ber:

 

4)ai(:

 

4)ai(:

 

5edera( Tax 8D:

 

5edera( Tax 8D:

 

Seg)ent 3ode:

 

 

 

 

 

 

 

 

Industry seg)ent (ist avai(ab(e at touris).ca.gov

Section 888. Ownership 3hanges to the 2usiness Location (isted in Section 8.

During the past year, have there been any of the fo((owing ownership changes? Note: The current owner is responsib(e for reporting )onths of gross revenue.

a.

3hange in 8dentity Na)e

No

b.

2usiness c(osed

No

c.

3hange in Ownership

No

d.

New 2usiness Location

No

Yes

Yes

Yes

Yes

New Na)e: Date of 3(osure:

Date of Opening/3hange: New 3ontact 8nfor)ation:

Section 8“. a 1ssess)ent 3a(cu(ation Note: if gross receipts for )onths are (ess than $ )i((ion see Section “.

5or purposes of ca(cu(ating the assess)ent for a business with a sing(e 548N nu)ber, that business )ay e(ect to be assessed based on the category and seg)ent in which it earns the )ost gross revenue, or based on the rate of assess)ent app(icab(e to each category or seg)ent 1cco))odations or Non-1cco))odations rate.

a. 4nter the ending )onth and year for the )onth period which you are reporting: The period shou(d ref(ect infor)ation fi(ed on the business' annua( tax return

b.Tota( 6ross Receipts fro) a(( operations for the period which you are reporting:

c.3o)p(ete assess)ent ca(cu(ation worksheet be(ow:

1SS4SSM4NT 31L3UL1T8ON ”ORKS744T:

a

Exa)p(e accounting period ending Dece)ber 5, enter / 5.

b

If gross receipts are (ess than $ )i((ion for )onths, see Section “.

6ROSS R4348PTS x P4R34NT TOUR8SM x R1T4 = 1SS4SSM4NT DU4

3

1cco))odations

$

x

x .

=

$

 

 

 

 

 

 

8nc(uding but not (i)ited

6ross 1cco))odations

Percentage of Touris):

1cco))odations Rate:

 

1cco))odations

to hote(s, resorts, )ote(s,

Receipts:

Round to nearest who(e percentage.

8nc(usive of any charges in conjunction

 

1ssess)ent 5ee:

inns, (odging,

4nter portion of (ine "b" that is derived

4nter percentage of revenue fro) "trave(

with on overnight stay.

 

Per 1cco))odations Rate

ca)pgrounds, R“ parks,

fro) acco))odations receipts. *See

and touris)" for acco))odations

 

 

 

Dude ranches, etc.

"acco))odation" exp(anation under

receipts. "Trave( and touris)" defined in

 

 

 

 

 

1cco))odations Rate.

Section 8“. b

 

 

 

3

Non-1cco))odations

$

x

x .

=

$

 

 

 

 

 

 

8nc(uding but not (i)ited

6ross Non-1cco))odations

Percentage of Touris):

Non-1cco))odations Rate:

 

Non-1cco))odations

to restaurants, retai(,

Receipts:

Round to nearest who(e percentage. 4nter

Non-1cco))odations: restaurant/retai(,

 

1ssess)ent 5ee:

attractions, trave( services,

4nter portion of (ine "b" that is derived

percentage of revenue fro) "trave( and

attractions/recreation, trave( services, not

 

Per Non-1cco))odations Rate

etc.

 

fro) non-acco))odations receipts.

touris)" for non-acco))odations

associated with services provided by an

 

 

 

 

 

receipts. "Trave( and touris)" defined in

acco))odation.

 

 

 

 

 

Section 8“. b

 

 

 

 

 

 

 

 

 

 

3T31

rev. / /

TOUR8SM 1SS4SSM4NT 5ORM

/

 

 

 

 

 

 

 

 

d.

1ssess)ent 3a(cu(ation: su) of 1ssess)ent 5ee fro) (ines 3

and 3 :

 

d

 

 

 

 

 

e

 

 

 

e.

Does your business pass the assess)ent fee on to the custo)er?

No

Yes

 

 

 

 

 

 

 

 

 

8f yes, enter the tota( a)ount co((ected fro) custo)ers on (ine

e

 

 

f

 

 

 

f.

1ssess)ent Due: 4nter the greater a)ount between (ines d

or

e :

 

 

 

 

 

 

 

 

 

 

 

8f gross receipts entered on (ine

b are (ess than a )i((ion, this business is considered exe)pt and no fees are due. See Section “.

 

 

Section 8“. b - 4xp(anation of 3hange in Trave( and Touris) Revenue:

 

 

 

 

 

8f your business has experienced a significant change in gross revenue or percentage of touris), p(ease provide a brief exp(anation be(ow and sub)it re(evant docu)entation with your

 

 

assess)ent for). The definition of Trave( and Touris) Revenue as stated within the 3a(ifornia 3ode of Regu(ations, Tit(e . 8nvest)ent, 3hapter

. , Touris) Marketing 1ct, Subchapter

. Definitions,

ee , is:

 

 

 

 

 

 

 

 

 

 

 

Trave( and Touris) Revenue )eans 3a(ifornia Gross Receipts derived fro) expenditures to and/or within 3a(ifornia by peop(e who trave( at (east fifty 5

)i(es

 

fro) ho)e, one way, for purposes other than co))uting to work or schoo( or

have an overnight acco))odation as part of the trave(, regard(ess of the distance

 

or purpose trave(ed. Ho)e as used in this definition )eans the p(ace where the person has resided for the )ost recent

consecutive days.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Section “. Docu)entation of 4xe)pt Status

8f any of the fo((owing provisions app(y, check the appropriate box. 1 Touris) 1ssess)ent 5or) )ust be sub)itted in order for your exe)pt status to be deter)ined. 1dditiona( docu)entation )ay be required. 1ny pay)ent sub)itted fro) an exe)pt business is considered a contract for vo(untary assess)ent and wi(( not be subject to refund. 6overn)ent

3ode

. d .

 

 

 

The business derives no 3a(ifornia gross receipts fro) any industry seg)ent. State business type:

 

The business is a trave( agency and/or a tour operator with (ess than

% of revenue derived fro) trave( within 3a(ifornia.

The business is a pub(ic entity or agency, i.e. govern)ent entity.

 

 

 

The tota( gross receipts entered in Section 8“. a , (ine b is (ess than $ ,

,

. 1ctua( gross receipts )ust be entered to qua(ify.

Percentage of Touris) entered in Section 8“. a is (ess than %. 1ctua( gross receipts )ust be entered to qua(ify.

Section “8. Optiona( Pay)ent of Maxi)u) 1ssess)ent

This business opts to pay the )axi)u) assess)ent of $ , . 8f a)ount co((ected fro) custo)er exceeds the )axi)u) assess)ent, then tota( co((ected )ust be re)itted to Office.

Section “88. 3ertification

8 certify or dec(are under pena(ty of perjury under the (aws of the State of 3a(ifornia that the foregoing is true and correct.

Date:

 

Signature of 1uthorized Representative:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Printed Na)e of 1uthorized Representative:

 

 

 

 

1ny person who fi(es fa(se infor)ation concerning an assess)ent is civi((y (iab(e in an a)ount of not )ore than ten thousand do((ars $ ,

,

 

8n addition to any a)ount owed as the assess)ent pursuant to 6overn)ent 3ode section

. .

 

 

 

 

 

 

 

 

 

 

Due Date: 5ebruary

,

 

 

 

 

 

Make checks payab(e to

3a(ifornia Trave( and Touris) 3o))ission.

 

 

 

 

 

Return the signed for) and pay)ent to our )ai(ing address:

 

 

 

 

 

 

Office of Touris)

 

 

 

 

 

 

PO 2ox

 

 

 

 

 

 

Pasadena, 31

-

 

 

 

 

 

”hen no pay)ent is due, the signed for) )ay be faxed to

-

or e)ai(ed to assess)ent@touris).ca.gov. 5or further assistance, contact the

 

 

Touris) 1ssess)ent Progra) at assess)ent@touris).ca.gov or ca((

-

.

 

 

 

3T31

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