room occupancy tax return...town of grover 207 mulberry road po box 189 grover, north carolina 28073...

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TOWN OF GROVER

207 Mulberry Road

PO Box 189

Grover, North Carolina 28073

704-937-9986

Fax 704-937-9377

Email [email protected]

ROOM OCCUPANCY TAX RETURN (TO BE FILED WITHIN 20 DAYS OF THE CLOSE OF EACH MONTH)

FOR THE MONTH OF ,?~vtll/#l f / ~. YEAR: 20 llf FIRM! OWNER NAME 771£ /tV';V cr IJI[ Prre!~7? MAILING ADDRESS ,I ?3() I c: 1- f t/~ IA",,1£/ mill/{J r

(}-(....J tl0t ;t/ L { ~Jio 71 r

PHYSICAL LOCATION S/!fi? £

PHONE NO,! E-MAIL (?J ~

TOWN OF GROVER 207 Mulberry Road

PO Box 189


704-937-9986

Fax 704-937-9377

Email townofgrover@carolina .rr.com


FOR THE MONTH OF fet; /',,/NL V YEAR: 20 1'1/' FIRM I OWNER NAME TJtL t:./# tV -y::---J?I[. j/~vt0 1~ MAILING ADDRESS ]01 cVt-£i/~ ~

(~U vU _ ,/'J(, 2/11) I

PHYSICAL LOCATION ~A. ~ LPHONE NO. / E-MAIL 7uY i) ) Yin

...----. IF NO SALES DURING THIS REPORTING PERIOD, CHECK HERE: II

L--.....!

»SEE BACK FOR COMPUTATION AND FILING INSTRUCTIONS - PLEASE READ CAREFULLY

COMPUTATON OF OCCUPANCY TAX SALES OCCUPANCY TAX

1. Gross Retail Receipts (Excluding Sales Tax) $ ?).>)..~O 2. Less: Receipts (This Month) On Rentals Exceeding 90 Days ( $ .- ) 3. Less: Credit On Previously Charged Exempt Receipts ( $ - -- . . L 4.

5.

Net Receipts

Occupancy Tax Due Town of Grover: Multiply Line 4 by 3%

$71. 7), ) 0 $ ;;L /!. Ir

6. Less: Operator Collection Fee Multiply Line 5 by 3% ( $ - ) 7. Sub-Total Line 5 minus Line 6 J--/ ? . / V 8. Penalty (See Instructions) $ ~

9. TOTAL DUE: Add Lines 7 and 8 $ ;LIt I r $ ;/5 , ( i>TOTAL AMOUNT REMITIED

CERTIFICATION:

This is to certify that this report, including all attachments, has been examined by me, and is, to the best of my knowledge

and belief. a true and complete report made in good faith covering the month indicated above and that same is in

accordance with the books and records of the reporting taxpayer.

DATE SIGNATURE /

Retum must be Signed by owner of business, by partner if a partnership, or if ~o.rp6ration by authorized officer.

mailto:[email protected]


PO Box 189


704-937-9986

Fax 704-937-9377



-~.

FOR THE MONTH OF ~Clf YEAR: 20 /tj FIRM / OWNER NAME IlrL f// tJ;::- ;7IL ;O~VTJ MAILING ADDRESS 'J61 C t- f-J/f u/V'ffJ 4-/?

/~~ ,-t/' c-, cJ--ltJ ).2 (

PHYSICAL LOCATION £'1!-;1j £

PHONE NO . 1 E-MAIL 937-clJi'h 1'1!f1V17/ .rJI 'i- 1tV',v' d;:-- 771f P-nrz.t.-J "O . cJ 11

L--

DIF NO SALES DURING THIS REPORTING PERIOD, CHECK HERE: »SEE BACK FOR COMPUTATION AND FILING INSTRUCTIONS - PLEASE READ CAREFULL


1. Gross Retail Receipts (Excluding Sales Tax) $ CjJ-? 6. CD 2. Less: Receipts (This Month) On Rentals Exceeding 90 Days ( $ - ) 3. Less: Credit On Previously Charged Exempt Receipts ( $ - ) 4. Net Receipts $ 7;Lfl . Q..,> 5. Occupancy Tax Due Town of Grover: Multiply Line 4 by 3% $ 2'/t.sf 6. Less: Operator Collection Fee Multiply Line 5 by 3% ( $ )

7. Sub-Total Line 5 minus Line 6 J. '7 J> s-f 8. Penalty (See Instructions) $ .-9. TOTAL DUE: Add Lines 7 and 8 $ 7/1. J'[

TOTAL AMOUNT REMITTED

CERTIFICATION

This is to certify that this report, including all attachments, has been examined by me, and is, to the best of my knowledge and belief, a true and complete report made in good faith covering the month indicated above and that same is in accordance with the books and records of the reporting taxpayer.

;PoTJf- wvf$ 0 j1../" 1- Vf.J·t-c~;Ajl

1-J-( - /1DATE SIGNATURE Return must be signed by owner of business, by partner if a partnership, or if acorpor Ion by authorized officer.


TOWN OF GROVER 207 Mul berry Road

PO Box 189


704-937 -9986

Fax 704-937-9377


ROOM OCCUPANCY TAX RETURN (TO BE FILED WITHIN 20 DAYS OF THE C' OSE OF EACH, MONTH)-

FOR THE MONTH OF ~;:J~/ L- YEAR: 20 / Lr FIRM j OWNER NAME 17t£ /N/ tJ/ -- TIlL, -- / ?JY!Y'06 T-f MAILING ADDRESS 3 D/ C t. £. j/£ U / P /ft/£NV'L-

~ /, ? ? '\] (; :--0 Vve.- /1/~ C, 0-- I ( t'

PHYSICAL LOCATION 1'4 /1 £PHONE NO, f E-MAIL

IF NO SALES DURING TH IS REPORTING PER IOD, CHECK HERE D

COMPUTATON OF OCCUPANCY TAX SALES OCCUPANCY TAX 1, Gross Retail Receipts (Excluding Sales Tax) S 6 IfPl j!)' 2, Less Receipts (This Month) On Rentals Exceeding 90 Days ( $ -- 1 3, Less: Credit On Previously Charged Exempt Receipts ( $ - ) 4. Net Receipts S 61-1/f , ~? 5. Occupancy Tax Due Town of Grover: Multiply Line a by 3% $ / 9r.bS

I 6. Less: Operator Collection Fee Multiply Line 5 by 3% ($ ~ I 7. Sub-Total line 5 minus Line 6 /9Lf, / -o~---8. Penalty (See instructions) $ 9, TOTAL DUE: Add Lines 7 and 8 $ / 'Ii, {s

TOTAL AMOUNT RE MITTED

CER! IFICAT ION This is to certify that this report, including all attachments, has been examined by me, and is, to the best of my knowledge and belief, a true and complete report made in good fai th covering the month indicated above and that same is in accordance 'with the books and records of the reporting taxpayer. fl

DATE /'1/11/ J C . Ii SIGNATURE ~f~· Return must be Signed by owner of business, by partner if a partnership. or if a,?orporati"fntv"author ized officer.


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PO Box 189


704-937-9986

Fax 704-937-9377



/?11/FOR THE MONTH OF ..r I YEAR 20 /'-1 FIRM / OWNER f\!P,ME T'rrL /~/>v t '?J::'-- TJl )'- /r/ l--j!/l} TS

/ A' I fJ /MAIUi\JG ADDRESS .-5 6 i { L- i tI£ LA,/(J . / ~/f../1/ l (-j(A) t' {;t ,;1;~ (. , .2tf/7J

!

PHYSICAL LOCATION 5///'-; [

PHONE NO. / E-MAIL

-,IF NO SALES DURING THIS REPORTING PERIOD, CHECK HERE:

-


1. Gross Retail Receipts (Excluding Sales Tax) $ 7, -J"' 11 .. .Ji ; ..2. Less: Receipts (This Month) On Rentals Exceeding 90 Days ( $ ). 3. Less: Credit On Previously Charged Exempt Receipts ( $ ) 4. i\let Receipts $/'-5 11, .>--t)I 5. Occupancy Tax Due Town of Grover: Multiply Line 4 by 3% ___ z~.j ) s- Jif$ 6. Less: Operator Collection Fee Multiply Line 5 by 3% -- .. 7. Sub-Total Line 5 minus Line 6

($

'" ') :-)

d- o- ~ ; 3tf 8. Penalty (See Instructions) ,~---$

..., 9, TOTAL DUE: Add Lines 7 and 8 $ .r :;L ,) ,3 i TOTAL AMOUNT REMITTED $

CERTIFICATION

This is to certify that this report, including all attachments, has been examined by me, and is, to the best of my knowledge and belief, a true and complete report made in good faith covering the month indicated above and that same is in accordance lI'Iith the books and records of the reporting taxpaj1er. /

,-' . ')) , /}////1 / DATE '''./ {j/ i.. ')-VI r!JILt SIGNATURE /~~

! / ) JK( / Return must be signed by owner of business, by partner if a partnership, or if a corporatioh by authorized officer.


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PO Box 189 Grover, North Carolina 28073

704-937 -9986 Fax 70i;·-937-9377

Email townofgrover@carolin a.rr.com

ROOM OCCUPANCY TAX RETURN (TO BE FILI=D WITH!N 20 DAYS OF THE Cl OSE OF EACH MONTH)

FOR THE MONTH OF J7Jfo/~ f-- YEAR 20 / if FIRM / OWNER NAME 17IZ- / /V;V O~ 7JlL r 1jV2/tl p MAILI NG ADDRESS 3 c ( L L- £- j/£ 0.AA:J d--/£/V'J/L

;t/e&!LalllL " ... . d-/! 'I) (

PHYSICAL LOCATION fA/t; [

PHONE NO. / E-MAIL ') U'-t -7J? -;2; q-O /1.tAy?../fIi!nl£ / /V ¥ tt;:'-TJIZ ~1f7flv/J Tf .

0 c O.'1iF NO SALES DURING THIS RE PORTiNG PERIOD. CHECK HERE


1. Gross Retail Receipts (Exclud ing Sales Tax) $ 10 'fJ7, '1-0 2. Less: Receipts (This Month) On Rentals Exceedin g 90 Days ( $ ------ ) 3. Less: Credit On Previously Charged Exempt Receipts ( $ .- ) 4. Net Receipts si U, t;~'1 , 'to 5. Occupancy Tax Due Town of Grover: Multip!y Line 4 by 3%

6. Less: Operator Collection Fee Multiply Line 5 by 3%

7. SUb-Total Line 5 minus Line 6

8. Penalty (See Instructions)

9. TOTAL DUE: Add Lines 7 and 8 -.

TOTAL AMOUNT RE MI TT ED

$

( $

$

$

50

:1; ] -

-") . ] ...> /

-]/J

J/J .

.

I / P ) I

I f'

71 ii

CERTiFICA t ION

This is to certify that this report. including all attachments, has been examined by me. and is. to the best of my knowledge and beilef, a true and complete report made in good faith covering the month indicated above and that same is in accordance with the books and records of the reporting taxpayer.

DAlE SIGNATURE

Return must be signed by owner of business. by partner if a partnership,



PO Box 189


704-937 -9986

Fax 704-937-9377



FOR THE MONTH OF \/yL- I--- YEAR 20 / 4 FIRM I OWNER NAME 77ff- / // /(.,~ 77fc:- r'4-)f0tJ r> MAILING ADDRESS 3 Jl C 1-- CZ ". ;: i/~'/v!: /1 ,4-v i~"/t,/[

/V~· C6-/L-b ;/~--1. / '-'~ fo ) ']

.f 4 ~ PHYSICAL LOCATION - ' / ,A.j

PHONE NO.1 E-MAIL 7J,7-·;2-9'tD 10,·t ;&r1/ 6') 71'? /.J/ tri~-nl V'--

IF NO SALES DURING THIS RE PORTING PERIOD, CHECK HERE -

» SEE BACK FOR COMPUTATION AND FILING INSTRUCTIONS - PLEASE READ CAREFULL


1 Gross Retail Receipts (Excluding Sales Tax) $ if I ) i) . tJb 2. Less: Receipts (This Month) On Rentals Exceeding 90 Days ( $ .- )

~~3. Less: Credit On Previously Charged Exempt Receipts 1$ 1 4. Net Receipts $111J O. ~ 5. Occupancy Tax Due Town of Grover: Multiply Line 4 by 3% $ .JJ}, Yf/{

~

6. Less : Operator Collection Fee Multiply Line 5 by 3% ,.($ )

7. SUb-Total Line 5 minus Line 6 ..23]/yt6 8. Penalty (See Instructions) $ t'~5fP y{.)~ 9. TOTAL DUE: Add Li nes 7 and 8 $ "':7'3 .] • c--;D

$ 3JJ. tj{) TOTAL AMOUNT REMITTED

CERTIFICATION:

This is to certify that this report, including all attachments, has been examined by ma, and is, to the best of my knol.'Aadge

and belief, a true and complete report made in good faith covering the month indicated above and that same is in

accordance with the books and reccrds of the reporting taxpayer.

'f)) . DATE d ~~ '/-'6 - /tr SIGNATURE -----

Return must be signed by owner of business, by partner if a partnership , or if a corpomtJf b authorized officer. • O



PO Box 189


704-937-9986

Fax 704-937-9377



FOR THE MONTH OF

FIRM / OWNER NAME

MAILING ADDRESS

PHYSICAL LOCATION

PHONE NO. / E-MAIL

IF NO SALES DURING THIS RE PORTING PERIOD, CHECK HERE:

»SEE BACK FOR COMPUTATION A~D FlUNG INSTRUc110NS - PLEASE READ CAREFULLY


11 Gross Retail Receipts (Excluding Sales Tax) $ /O/!JLf./O 2. Less: Receipts (This Month) On Rentals Exceeding 90 Days ( $ )

3. Less : Credit On Previously Charged Exempt Receipts ( $ )

4. Net Receipts $ / () I / J 'I, /7) 5. Occupancy Tax Due Town of Grover: Multiply Line 4 by 3%

I

$ J t> '-t. {~ 6. Less: Operator Collection Fee Multiply Line 5 by 3% ($ J ) 7. Sub-Total Line 5 minus Line 6 I 8. Penalty (See Instructions) $ J/ 9. TOTAL DUE: Add Lines 7 and 8 $

'I

TOTAL AMOUNT REMITTED $ :!o'f.b~

CERTIFICATION

This is to certify that this report, including all attachments, has been examined by me, and is, to the best of my kno'A~edge and belief, a true and complete report made in good faith covering the month indicated above and t accordance with the books and records of the reporting taxpayer.

DATE SIGNATURE

Return must be signed by owner of business, by partner if a partnership, or if acorporation by authorized officer. /fJ-VP~ S14~ ~.nr-~./ vv£~A ~



PO Box 189


704-937-9986

Fax 704-937-9377



5?~?i/'Z 4 l-& L...

MAILING ADDRESS J~/ e-l- £//{ U~ kt. .vVf-. /

~VL- ;t/C :2--/oIJ

PH YS ICAL LOCATION Sfr/l'I- ff>' #1>/2:.

PHONE NO . 1 E-MAIL 13 7-~ f't.i/ ~17jJ/---l!Z-/~vv/ /1~;Jff)1.Itf1~. U,)l.

IF NO SALES DURING THIS REPORTING PERIOD, CHECK HERE D ..

» SEE BACK FOR COMPUTATION AND FILING iNSTRUCTIONS - PLEASE RE;AD CAREFULL


1. GI'OSS Retail Receipts (Excluding Sales Tax) I $ JJ-LfI..Oo I

2. Less Receipts (This Month) On Rentals Exceeding 90 Days ( $ )

3.

4.

Less: Credit On Previously Charged Exempt Receipts

Net Receipts

( $ r7 "'tl . . ' $ ~ ,Db ) 5. Occupancy Tax Due Town of Grover: Multiply Line 4 by 3% $ clLji,) J 6. Less: Operator Collection Fee Multiply Line 5 by 3% ( $ - ) 7. Sub-Total Line 5 minus Line 6 :J. Lf 7, "t 3 8. Penalty (See Instructions) $ ------9. TOTAL DUE: Add Lines 7 and 8 $ ;) if 7, "J.--3

TOTAL AMOUNT REMITTED

CERTIFICATION

This is to certify that th is report, including all attachments, has been examined by me, and is, to the best of my knowledge and belief accordance With the books and records of tile reportlllg taxpayer

DATE /1J -)-0 -/4' SIGNATURE Return must be signed by owner of business, by partner if a partnership, Oi if a 'corpor tion by authorized officer.

a true and complete report made In good faith cOllenng the month Indicated above and that same IS In-1-----j/'--,j-f1--:::;;o~~_;--/------


. ,

CLEVELAND COUNTY, NC OCCUPANCY TAX SECTION

PO BOX 370, SHELBY, NC 28151-0370 (704) 484-4921


" FORTHE MONTH OF _ 0 •• 06 :1 U0(/:~7" ' " " The Irul. of t h e Patr iot s, LLC

FIRM/OWNER NAME

3 0 1 Cleveland MAILING ADDRESS

Av e n u e, Gro"Ve r I NC

PHYSICAL LOCATION Same as above

" YEAR: 20/Lr

28073

PHONE # /EMAIL 70 4 - 937 - 2 940 mar t i @theinI1o f t h epa t r i ots.com

IF NO SALES DURING THIS REPORTING PERIOD, CHECK HERE:

D

»_REFEB TO BACK PAGE-FOR FILlNG. INSTRUCTION.AN01:0MP_UTATION« ,

COMPUTATION OF OCCUPANCY TA)( , SALES OCCUPANCY TAX

1. Gross Retail Receipts (Excluding Sales Tax)

2. Less: Receipts(This Month) on Rentals Exceeding 90 days

3, Less: Credit on Previously Charged Exempt Receipts

4 . Net Receipts

5. Occupancy Tax Due Cleveland County: Multiply Line 4 by 3%

6. Occupancy Tax Due City of Shelby: Multiply Line 4 by 3%

7. Occupancy Tax Due Boiling Springs: Multiply LIne 4 by 3%

8. Total Occupancy Tax Add Lines 5 thru 7

9. Less: Operator Collection Fee Multiply Line 8 by 3%

10. Sub-Total

11. Penalty (See Instruction) r-------------------------------,

12. Total Due: Lines 10 and 11

$ -$

>

CERIIFICAIIDN: TQIAI , AMQl1NI.REMYTTED $ This is to certify that this report, including all attachments, has been examined by me, and is, to the hest of my knowledge and belief, a true and complete report made in good faith covering the month indicated above and that same is in a ance with the books and records of the reporting taxpayer.

/4Date !lJ!? tI )---0/ '--J.--- Signature

7

Return must be signed by owner of business, by partner if partnership, or if corporation by authorized officer.

I


PO Box 189


704-937 -9986

Fax 704-937-9377



FOR THE MONTH OF

FI RM I OWNER NAME

MAl LI NG ADDRESS

}/() t/t 11 jJ Vi.-The Inn of the Patriots, LLC

301 Cleveland Avenue, Grover, NC 28073

YEAR: 20 /i

PHYSICAL LOCATION Same as above

704-937-2940 [email protected] PHONE NO. fE-MAIL

IF NO SALES DURING THIS REPORTING PERIOD, CHECK HERE: D

»SEE BACK FOR COMPUTATION AND FILING INSTRUCTIONS - PLEASE READ CAREFULL


1. Gross Retail Receipts (Excluding Sales Tax) $ 7iJ,S,ifP 2. Less: Receipts (This Month) On Rentals Exceeding 90 Days ( $ ) 3. Less: Credit On Previously Charged Exempt Receipts ( $ )

4. Net Recei pts $7RU,IfJ' 5. Occupancy Tax Due Town of Grover: Multiply Line 4 by 3% $ :J.Jtf,76 6. Less: Operator Collection Fee Multiply Line 5 by 3% . ($ - ) 7. Sub-Total Line 5 minus Line 6 J...]'t 7& 8. Penalty (See Instructions) $

9. TOTAL DUE: Add Lines 7 and 8 $ c2] if, "} ~

$J-J '-to 2 ( TOTAL AMOUNT REMITTED

CERTIFICATION:

This is to certify that this report, including all attachments, has been examined by me, and is, to the best of my knowledge

and belief, a true and complete report made in good faith covering the month indicated above an


DATE SIGNATURE/J.- ~11--- It that same is in

Return must be signed by owner of business, by partner if a partnership, or if a corporation by authorized officer.

mailto:[email protected]:[email protected]

--


PO Box 189


704-937 -9986

Fax 704-937-9377



FOR THE MONTH OF f}Z(Z/1b

-----

---

--

/


PO Box 189

Grover, r--..lortil Carolina 28073

704-937 -9986

Fax 704-937-9377

Email townofgrover@carolina .rr.com


(;/T;Jl/YYvf~FOR THE MONTH OF YEAR: 20 - Is-The Inn of the Patriots, LLC

FIRM / OWNER NAME

301 Cleveland Avenue, Grover, NC 28073 M,L\ILlNG ADDRESS

-Same as above

PHYSICAL LOCATION

704-937-2940 [email protected] PHONE NO. / E-MA,IL -IF NO SALES DURI NG THIS REPORTING PERIOD, CHECK HERE

: . •• • • I .G INSTRUCTIONS -; PLEASE READ CARaFULL COMPUTATON OF OCCUPANCY TAX SALES OCCUPA~ICY TAX

i1

$ ). lo , if- .r ( $ - )

Gross Retail Receipts (Excluding Sales Tax) $ ?6f )/7.) I 2. Less . Rooopt, (Thi' Mooth) 00 Reotel, Exceediog 90 Dey, ( $ - f I) 3. Less Credit On Previously Charged Exempt Receipts ( $ )

-----------------+~~~ /4. Net Recei pts I $ {)- , 7)"

5 Occupancy Tax Due TOII'm 0'Grover Multiply Line 4 by 3% 6. Less Operator Collection Fee Multiply Line 5 by 3%

7. Sub-Total Line 5 minus Une6 'd-Cu, t,fj 8. Penalty (See Instructions) $ 9. TOTAL DUE: Add Lines 7 and 8

TOT,6,L AMOUNT REMITTED

CERTIFICATION

Tilis is to certify that this report, including all attachments, has been examined by me, and is , to the best of my knowlec'ge and belief, a true and complete report made in good faith covering the month indicated above and that same is in

accordance with the books and records of the reporting taxpayer. ~/L -DATE J-- d-U -Is SIGNATURE ~

Return must be signed by owner of busines;, by partner if a partneishi p, or if cor~O:::;b


PO Box 189


704-937 -9986

Fax 704-937-9377



FOR THE MONTH OF

FI RM I OWNER NAME

MAILING ADDRESS

fit/l1/I/:/C, J~ The Inn of the Patriots, LLC


YEAR 20 If"j~

-Same as above

PHYSICAL LOCATION

704-937-2940 [email protected] PHO N E NO. I E-Mp.,fL

IF NO SALES DURING THIS REPORTING PERIOD, CHECK HERE: D » SJ:E BACK FOR CO!ViIPUTATION AND FILING INSTRUCTIONS -; PLEASE READ CAR! : FULL


1.

2.

3.

Gross Retail Receipts (Excluding Sales Tax)

Less Receipts (This Month) On Rentals Exceeding 90 Days

Less: Credit On Previously Charged Exempt Receipts

$/0 ( $

( $

J't 1,1D -- )- )

4. Net Recei pts $/0/J11, J 0 5. Occupancy Tax Due Town of Grover: Multip!y Line 4 by 3% $ J/O . ~'f 6. Less: Operator Collection Fee Multipy Line 5 by 3% ( $ ~ )

7. Sub-Total Line 5 minus Line 6 1/ u , ;.. L{ 8.

9.

Penalty

TOTAL DUE:

(See Instructions)

Add Lines 7 and 8

$ -$ 3/0, )-'1 )) U

TOTAL AMOUNT REMITIED $ / cJ, "'"' (

CERTIFICATION:

This is to certify that this report, including all attachments, has been examined by me, and is, to the best of my knowledge and belief, a true and complete report made in good faith covering the month indicated above and that same is in accordance ....lith the books and records of the reporting taxpayer .

3-h~/.rDATE SIGNATURE Return must be signed by owner of business, by partner if a partnershi p, or if a- cor

mailto:[email protected]:[email protected]

--

Return must be signed I:¥ O'M1er of business, try- partner if a partnershi p, or if a corporation by authorized officer.


PO Box 189


704-937-9986

Fax 704-937-9377

Email townofgrover@carolina. rr. com

ROOM OCCUPANCY TAX RETURN (TO BE FILED WI THIN 20 DAYS OF THE CLOSE OF EACH MONTH)

FOR THE MONTH OF

FI RM I OWNER NAME

MAIUNG ADDRESS

?iIHL {1-1 The Inn o f the Patriots, LLC


YEAR: 20 IJ

PHYSICAL LOCATIO N Same as above

704-937-2940 m arti@theinnofthe patriots.com PHO NE NO. / E- MAIL

IF NO SALES DURING THIS REPORTING PERIOD, CHECK HERE C

» SEE BACK FOR COMPUTATION AND FILING INSTRUCTIONS - PLEASE READ CAREFULL


1. Gross Retail ReceiIXs (Excluding Sales Tax) $ 1t1 s-;: rt 2. Less: Receipts (This Month) On Rentals Exceeding 90 Days ( $ )

3. Less: Credit On Previously Charged Exem pt Receipts ( $ )

4. Net Recei IXs $ 7./.FJ,16 5. Occupancy Tax Due Town of Grover: Multiply Une 4 by 3% $ 17Lf, 6 ') 6. Less: Operator Collection Fee Multiply Une 5 by 3% ( $ - ) 7. SutrTotal Une 5 minus Une 6 '1 7if . {7 8. Penalty (See Instructions) $

9. TOTAL DUE: Add Unes 7 and 8 $d-)t-r. /7 TOTAL AMOUNT REMITTED

CERTIFICATION:

This is to certify that this report, including all attachments. has been examined by me, and is, to the best of

and belief. a true and complete report made in good faith covering the month indicated above a d that s


Lf - J, fJ -- ISDATE SIGNATURE

room occupancy tax return...town of grover 207 mulberry road po box 189 grover, north carolina 28073...

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