WALLOWA COUNTY

TRANSIENT LODGING TAX REGISTRATION FORM

     PLEASE COMPLETE AN RETURN TO:                         W.C. TREASURER   

                                                                                                    101 S. RIVER ST. RM. 103

                                                                                                    ENTERPRISE, OR. 97828

                                                                                                    541-426-4543 #153

     PLEASE PRINT OR TYPE

     BUSINESS      _____________________________                 DATE OF APPLICATION ________________

     OWNER          _____________________________  

     OPERATOR   ______________________________

     MAILING       ______________________________              PHONE #_____________________

     ADDRESS       ______________________________              FAX #        ____________________

     LOCATION ______________________________                NUMBER OF

                                                                                                                ROOMS/SPACES______________

     ADDRESS    ______________________________

     I DECLARE, UNDER PENALTY OF MAKING FALSE STATEMENT, THAT TO THE BEST OF MY KNOWLEDGE AND               BELIEF, THE STATEMENTS HEREIN ARE CORRECT AND TRUE.

SIGNED          ______________________________________

DATE              ______________________________________

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                                                                    OFFICE USE ONLY:

     CERTIFICATE/ACCOUNT NUMBER         ____________________

     DATE OF ISSUANCE OF CERTIFICATE   ____________________

COUNTY          ENTERPRISE          JOSEPH           WALLOWA