COUNTY OF CLINTON MONTHLY HOTEL TAX REPORTING FORM(Updated)

COUNTY OF CLINTON MONTHLY HOTEL TAX REPORTING FORM
Make checks payable & remit to: Clinton County Treasurer 2 Piper Way, Suite 124 Lock Haven, Pa 17745 Phone: 570-893-4004

THIS REPORT IS TO BE FILED MONTHLY, PURSUANT TO COUNTY CODE ACT OF AUGUST 9, 1955 (P.L. 323, NO. 130) AS AMENDED, P.S. $1770.6 AND CLINTON COUNTY ORDINANCE NO. 2016- 1, 2022-4 FOR COUNTY TREASURER'S OFFICE USE ONLY
All lines below must be completed and not remain blank!
BUSINESS NAME
ADDRESS
CITY
STATE:PA
ZIP
CONTACT INDIVIDUAL OWNER
PHONE NUMBER
EMAIL
example@example.com
Federal EIN
TAX PAYER (OPERATOR) SECTION:
Reporting Period: From
Reporting Period: To
A. GROSS RECEIPTS FROM ROOM RENTALS
B. LESS EXEMPT RECEIPTS
C. NET TAXABLE RECEIPTS
D. TAX DUE AT 50 OF NET RECEIPTS
E. AMOUNT SUBMITTED BY AN AIR BNB
F. LATE FEE 15 PER MONTH
G. TOTAL TAX PAYMENT DUE D F
*Operators are obligated to maintain records to support and identify this type of exemption i.e. copies of the exemption certificate or other identifying documents.

Hotel Tax is imposed at the rate of 5% of the taxable receipts received by each operator of a facility within Clinton County. The tax is to be collected by the operator of each facility from each patron who rents a room. Each operator is required by law to file a tax return, and remit tax due within 30 days after the end of each quarter. If there is no tax due for a given period, file return indicating ".00" on Total Tax Payment Due (line G Failure to remit timely payment may result in civil and/or criminal charges, including fines, penalties, and attorney's costs, as allowed by law. I hereby certify that the information contained herein is true and correct to the best of my knowledge, and is a disclosure of all tax collected or incurred during the period indicated.
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COUNTY OF CLINTON MONTHLY HOTEL TAX REPORTING FORM

STATE:PA

TAX PAYER (OPERATOR) SECTION: