Fairfield County, Ohio

Hotel/Motel Operators Occupancy Tax Return

ORC 5739.09

Hotel/Motel Name and Remittance Address

Parcel Number

Property Address

Remit Tax Quarterly as noted

Please indicate which quarter this form is in reference to by checking one of the following:

Quarter selection

For the sales period of JAN – MAR, tax is due on or before April 30th

For the sales period of APR - JUN, tax is due on or before July 31st

For the sales period of JUL – SEPT tax is due on or before October 31st

For the sales period of OCT - DEC tax is due on or before January 31st

Tax Calculation

1. Gross Room Sales for Quarter	Line 1
2. Exempt Sales for Non-Transient Guests	Line 2
3. Other exemptions (attach copy of exemption certificate)	Line 3
4. Total Exempt Sales (add lines 2 and 3)	Line 4
5. Net Taxable Sales (line 1 less line 4)	Line 5
6. Tax Due for Fairfield County Visitors and Convention Bureau (enter 3% of line 5) (Does not apply in Reynoldsburg)	Line 6
7. Tax Due for Cultural Arts Facility (1.5% of line 5) (Including Reynoldsburg)	Line 7
8. Total Tax Due for current quarter (add lines 6 and 7)	Line 8
9. Credit or Debit (over or underpayment in prior quarters)	Line 9
10. Amount Enclosed (add lines 8 and 9)	Line 10

I declare under penalty of perjury that this return, including any attachments, has been examined by me, and to the best of my knowledge and belief is a true, correct, and complete return.

Signed

Date:

Title:

Make check payable to Fairfield County Treasurer.

Mail tax return, checks, and correspondence to:

Carri L. Brown, PhD, MBA, CGFM

Fairfield County Auditor

210 East Main Street

Lancaster, Ohio 43130

P: (740) 652-7020

Email: kayla.speakman@fairfieldcountyohio.gov

If business is no longer operating or if a change in ownership, corporate structure, or tax status has occurred, please notify the County Auditor by calling (740) 652-7020.