Dayton has been manufacturing some of the best form hms on the market for years. The Dayton Form HM 4 is a great example of their quality and craftsmanship. With its durable steel construction, this form hm will be able to handle even the most strenuous jobs. And its precision-milled surfaces make it perfect for creating accurate forms. So if you're looking for a tough, reliable form hm, the Dayton Form HM 4 is definitely worth considering.
| Question | Answer |
|---|---|
| Form Name | Dayton Form Hm 4 |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | MotelTaxform city of dayton lodging tax form |
For Office Use Only
FORM
City of Dayton Income Tax
PO Box 8746
Dayton, Oh.
Tele. (937)
www.cityofdayton.org
For Period of_________________________ To_____________________________
Account Number:
Name
Address
City, State, Zip
1. Gross Receipts (All Hotel/Motel Lodging Furnished Guests)
2. Exempt Receipts (Permanent Guests, Continuous Lodging Over 30 Days)
3. Other Exemptions (Attach Exemption Certificates)
4. Total Exempt Receipts (Add Lines 2 and 3)
5. Net Taxable Receipts (Line 1 Minus Line 4)
6. Tax Due (Line 5 x .03)
7. Adjustments - Prior Period - (Attach Explanation)
8. Penalty (10% Per Month For Late Payment)
9. Interest (1% Per Month For Late Payment)
10. Total Amount Due (Add Lines 6, 7, 8, and 9)
I hereby certify that the information and statements contained herein and in any schedule of exhibits are true and correct.
Signature_________________________________ Title____________________________ Date __________________
NOTIFY THE DIVISION
OF REVENUE AND
TAXATION PROMPTLY
OF ANY CHANGE IN
OWNERSHIP OR NAME
AND ADDRESSIn the event that your check is returned unpaid for insufficient or uncollected funds, we may electronically debit your account for the principal amount of the check