Hotel Accommodations Tax Return

NOTE:

You must fill this form out completely. If any information is omitted, this return will be deemed incomplete and penalties may be applied.

The totals on this form are not the final totals due. The total amount due may be subject to late payment and penalty fees.

An Invoice with the final amount will be sent.

Reporting Entity Name*

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Federal Tax ID#

IL Sales Tax ID #

Month*

Year*

1. Gross receipts from hotel accommodations

2. Authorized deductions:

a. Tinley Park hotel accommodations tax included in line 1

b. Gross receipts for permanent residents

c. Hotel taxes collected by the State of Illinois

d. Hotel taxes collected by the County of Cook

Total authorized deductions (Lines a+b+c+d)

3. Net amount subject to tax (Line 1-2)

4. Tax due @ 7% of line 3

Under penalty as provided by law, I declare that I have examined this return and to the best of my knowledge and belief, the information is true, correct, and complete.

Printed Name:*

Email*

example@example.com

Title*

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Signature

VILLAGE OF TINLEY PARK

This return is filed for: