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2. REPORTING PERIOD MONTHS*

   Please check all that apply.

   1. 1st Quarter - January through March
   2. 2nd Quarter - April through June
   3. 3rd Quarter - July through September
   4. 4th Quarter - October through December
   5. Monthly Reporting
3. If Monthly Reporting:

   What month are you reporting for?

   *Note: if you checked the "Monthly Reporting" box in the first section, you MUST answer this question.

4. DUE DATES

   ALL REPORTING IS DUE BY OR BEFORE 5PM ON THE 20th OF THE MONTH FOLLOWING THE END OF A REPORTING PERIOD.

   1st Quarter - APRIL 20th
   2nd Quater - JULY 20th
   3rd Quarter - OCTOBER 20th
   4th Quarter - JANUARY 20th

6. Hotel Name:*
8. Location Address:*
10. Mailing Address:*
12. Taxpayer I.D. Number:*
14. Contact Name:*
15. Contact Phone Number:*
16. Contact Email:*
20. Please Provide the Following Information

    All required information and suplimentary reports MUST be entered in order to complete the submisssion of this form.

22. Motel Statistics Report*
23. A. Total Room Receipts*

    Motel Statistics Report Must be Submitted with This Form

25. Tax Exemption Report*
26. B. Less Tax Exemptions*
29. C. Taxable Receipts*

    Line A minus Line B

32. D. Tax Due*

    Multiply Line C by 7%

35. E. Discount 1%

    Multiply Line D by 1% if paid by due date.

38. F. Total Taxable Receipts*
41. G. Penalty

    -A penalty of 5% of the tax due will be imposed if the tax is not paid by the due date.
    -An additional penalty of 5% of the tax will be imposed every thirty (30) days past the the due date that the tax is not paid.

44. H. Interest

    If applicable, interest accrues at a rate of 10% per annum beginning sixty (60) days from the date the tax was due.

47. I. Balance Owed From Preceding Quarters

    Includes penalty and interest.

50. J. Total Due to City of Decatur*

54. By checking the "I agree" box below, you agree and acknowledge that 1) this form will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

56. I agree to the above statement, and I declare, under penalties prescribed, that the information contained in this document is true and correct to the best of my knowledge.*

    1. I AGREE
Leave This Blank:


58. 1. Receive an email copy of this form.
59. Email address

    This field is not part of the form submission.

60. Submit

* indicates a required field