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WALLOWA COUNTY TREASURER’S OFFICE
WALLOWA COUNTY COURTHOUSE
TRANSIENT LODGING TAX RETURN FORM 101 S RIVER ST. RM 103
ENTERPRISE, OR 97828
ACCOUNT NUMBER __________________ CIRCLE QUARTER & DUE DATE
BUSINESS ____________________________ 1ST 2ND 3RD 4TH
NUMBER OF ROOMS/SPACES _________ APR JUL OCT JAN
CALCULATION OF TAX RETURN
1. GROSS RENT
2. a. RENT BY THE MONTH
b. OTHER RENT DEDUCTIONS
3. TOTAL ALLOWABLE DEDUCTIONS
{ SUM OF LINES 2.a. THRU 2d. }
4. TAXABLE RENTS
{ LINE 1 MINUS LINE 3 }
5. TAX
{ 5% OF LINE 3 }
6. EXCESS TAX COLLECTED
7. TOTAL TAX
{ SUM OF LINES 5 & 6 }
8. COLLECTION EXPENSE
{ 5% OF LINE 7 }
9.TOTAL TAX DUE
{ LINE 7 MINUS LINE 8 }
10. PENALTY
11. INTEREST
12.ADJUSTMENT FOR PRIOR UNDERPAYMENT OR
(OVERPAYMENT)
13. TOTAL RETURN
{ TOTAL OF LINES 9 THRU 12 }
I DECLARE, UNDER PENALTY OF MAKING A FALSE STATEMENT, THAT TO THE BEST OF KNOWLEDGE AND BELIEF, THE FIGURES HEREIN ARE CORRECT AND TRUE.
SIGNED__________________________________________ DATE____________________
PAYMENTS MUST BE IN THE TREASURER'S OFFICE NO LATER THAN THE END OF OF THE MONTH.
POSTMARKS WILL NOT BE ACCEPTED
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