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2. 
3. City of Fitchburg 5520 Lacy Road Fitchburg, WI 53711 (608) 270-4271
   TRANSIENT ROOM TAX QUARTERLY RETURN Municipal Code - Chapter 2 (new rate effective 1/1/17)
7. Name of Hotel/Motel*
8. Quarterly Report Date Range*
   Quarterly Report Date Range Start Date

   —

   Quarterly Report Date Range End Date
9. Payment Due*
   Payment Due
11. Street Addres of Hotel/Motel*
12. City, State, Zip*
16. The Hotel/Motel tax imposed by Chapter 2 of the Municipal Code of the City of Fitchburg, is payable on a calendar quarter basis. Payment of tax is due on or before the last day of the month next succeeding the calendar quarter for which imposed. Each payment shall be accompanied by a completed quarterly return prepared by the taxpayer.
18. Lines
19. COMPLETE ALL SECTIONS
20. Amount
22. Line 1
23. Gross room receipts for quarterly period
24. Amount*
26. Line 2
27. Deduct non-transient receipts
28. Amount*
30. Line 3
31. Deduct tax exempt receipts
32. Amount*
34. Line 4
35. TAXABLE ROOM RECEIPTS (Line 1 minus 2 & 3)
36. Amount*
38. Line 5
39. GROSS TAX (7% of line 4)
40. Amount*
42. Line 6
43. Late filing fee ($25 plus interest*)
44. Amount*
46. Line 7
47. TOTAL TAX DUE (Line 5 plus 6)
48. Total Amount*
52. Name and address of person or firm preparing report
53. CERTIFICATION: Under penalty of perjury, I hereby certify that the information provided here in is accurate to the best of my knowledge and belief.
55. Name*
56. Signature*
58. Street Address*
59. Title*
61. City, State, Zip*
62. Phone Number*
64. Email Address*
65. Date*
    Date
67. Make check payable to the City of Fitchburg. Mail tax return and check to: 5520 Lacy Road, Fitchburg, WI 53711
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73. 1. Receive an email copy of this form.
74. Email address

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75. Submit Submit and Print

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