Form Center

2. 
3. City of Fitchburg 5520 Lacy Road Fitchburg, WI 53711 (608) 270-4271
   2017 ANNUAL RECONCILIATION OF TRANSIENT ROOM TAX
7. Name of Hotel/Motel*
8. Payment Due*
   Payment Due
10. Street Addres of Hotel/Motel*
11. City, State, Zip*
15. THIS FORM IS TO BE COMPLETED FOR THE CALENDAR YEAR INDICATED
17. Line 1
18. Annual Gross room reciepts
19. Amount*
21. Line 2
22. Deduct Annual non-transient receipts
23. Amount*
25. Line 3
26. Deduct Annual tax exempt receipts
27. Amount*
29. Line 4
30. ANNUAL TAXABLE ROOM RECEIPTS (Line 1 minus 2 & 3)
31. Amount*
33. Line 5
34. ANNUAL GROSS TAX (7% of line 4)
35. Amount*
37. Line 6
38. Taxes paid according to Quarterly Reports filed for:
41. 6A. Quarter ended March 31 (Months of Jan, Feb, & March)
42. Amount*
45. 6B. Quarter ended June 30 (Months of April, May, & June)
46. Amount*
49. 6C. Quarter ended September 30 (Months of July, Aug, & Sept)
50. Amount*
53. 6D. Quarter ended December 31 (Months of Oct, Nov, & Dec)
54. Amount*
57. 6E. Total (Add lines 6A, 6B, 6C, & 6D together)
58. Amount*
60. Line 7
61. If line 5 is more than line 6E, enter the difference as the TAX DUE (if tax is due, include payment and detailed explanation to City of Fitchburg)
62. Amount*
64. Line 8
65. If line 6E is more than line 5, enter the difference as the amount OVERPAID (please provide explanation of error. This overpayment will be refunded to you upon verification.
66. Amount*
70. Name and address of person or firm preparing report
71. I hereby declare that this Reconciliation is true and complete to the best of my knowledge and belief.
73. Name*
74. Signature*
76. Street Address*
77. Phone Number*
79. City, State, Zip*
80. Date*
    Date
82. Email Address*
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88. Submit Submit and Print

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