-
---
--
/
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
Grover, North Carolina 28073
704-937-9986
Fax 704-937-9377
Email townofgrover@carolina .rr.com
ROOM OCCUPANCY TAX RETURN (TO BE FILED WITHIN 20 DAYS OF THE
CLOSE OF EACH MONTH)
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]
-
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 ~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
COMPUTATON OF OCCUPANCY TAX SALES OCCUPANCY TAX
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.
mailto:[email protected]
-
TOWN OF GROVER 207 Mul berry 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 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.
mailto:[email protected]
-
--
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)
/?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:
-
COMPUTATON OF OCCUPANCY TAX SALES OCCUPANCY TAX
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.
mailto:[email protected]
-
- -
TOWN OF GROVER 207 Mulberry Road
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
COMPUTATON OF OCCUPANCY TAX SALES OCCUPANCY TAX
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,
mailto:[email protected]
-
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 \/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
COMPUTATON OF OCCUPANCY TAX SALES OCCUPANCY TAX
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
mailto:[email protected]
-
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
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
COMPUTATON OF OCCUPANCY TAX SALES OCCUPANCY TAX
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 ~
mailto:[email protected]
-
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)
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
COMPUTATON OF OCCUPANCY TAX SALES OCCUPANCY TAX
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~~_;--/------
mailto:[email protected]
-
. ,
CLEVELAND COUNTY, NC OCCUPANCY TAX SECTION
PO BOX 370, SHELBY, NC 28151-0370 (704) 484-4921
ROOM OCCUPANCY TAX RETURN (TO BE FILED WITHIN 20 DAYS OF THE
CLOSE OF EACH MONTH)
" 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
-
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
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
COMPUTATON OF OCCUPANCY TAX SALES OCCUPANCY TAX
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
accordance with the books and records of the reporting
taxpayer.
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]
-
--
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 f}Z(Z/1b
-
-----
---
--
/
TOWN OF GROVER 207 Mulberry Road
PO Box 189
Grover, r--..lortil Carolina 28073
704-937 -9986
Fax 704-937-9377
Email townofgrover@carolina .rr.com
ROOM OCCUPANCY TAX RETURN (TO BE FILED WITHIN 20 DAYS OF THE
CLOSE OF EACH MONTH)
(;/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
-
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
FI RM I OWNER NAME
MAILING ADDRESS
fit/l1/I/:/C, J~ The Inn of the Patriots, LLC
301 Cleveland Avenue, Grover, NC 28073
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
COMPUTATON OF OCCUPANCY TAX SALES OCCUPANCY TAX
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.
TOWN OF GROVER 207 Mulberry Road
PO Box 189
Grover, North Carolina 28073
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
301 Cleveland Avenue, Grover, NC 28073
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
COMPUTATON OF OCCUPANCY TAX SALES OCCUPANCY TAX
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
accordance with the books and records of the reporting
taxpayer.
Lf - J, fJ -- ISDATE SIGNATURE