Certificate of Registration and Application for Certificate of Authority to Collect Hotel or Motel Room Occupancy Tax

Certificate of Registration and Application for Certificate of Authority to Collect Hotel or Motel Room Occupancy Tax
Employer Identification Number*
Business Name*
Individual, Trade Name or Corporate Name
Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Location of Business*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
List Individual, Partners, or Principle Officers (if Corporation)*
Submitter Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Submitter Email
example@example.com
Number of Rooms*
HotelMotelOther
IndividualPartnershipCorporation
Date Started in Business in Chemung County*

MonthDayYear
If started after January 1, 1989
YesNo
Name under which they operated
Their Registration Number
YesNo
List Each One*
Consolidated ReturnSeperate Return for each Location
Registration

The Board of Legislators of the County of Chemung has provided by law as follows:

Every hotel motel operator shall file with the County Treasurer a certificate of registration in a form prescribed by him. The Treasurer shall promptly thereafter issue without charge to each hotel /motel operator a certificate evidencing the authority of such to collect the tax from the occupants and duplicates thereof for each additional place of business of such operator. Each certificate or duplicate shall state the place of business to which it is applicable.

Penalties

Any hotel/motel operator willfully fails to file a registration certificate, surrender the certificate of authority as required, or assign or transfer such certificate of authority. shall be liable to the penalties provided by law.
I hereby certify that the statements made herein have been examined by me, and are to the best or my knowledge and belief, true and complete.
Signature*

Powered by Jotform SignClear
Title*
Should be Empty: