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Room Occupancy Tax Remittance Form

  1. **THIS FORM IS TO BE PRINTED OUT ONLY**

  2. Room Occupancy Tax Remittance Form

  3. Quarterly Payment

  4. *File this return with your remittance for the amount of tax due for the reporting period, on or before the due date (see schedule above). The failure to file a return or pay the amount due within the time required by law shall be subject to a penalty of 5% of the amount due per month or any fraction of a month to a maximum of 25% for each year; plus interest at the rate of 1% of such tax for each month of delay or fraction of a month after such return was required to be filed or such tax became due.

  5. Make remittance payable and mail return to: CITY OF WHITE PLAINS-DEPT OF FINANCE 255 Main Street, White Plains, NY 10601

  6. Certification of Taxpayer: Under penalties of perjury, I declare that I have examined this return, and to the best of my knowledge and belief, it is true, correct and complete.

  7. Signature___________________________________

  8. Title_______________________________________

  9. Date___________________________________

  10. Leave This Blank: