Quarterly Report
Collections of Short Term Rental Tax

Instructions:
This form and payment must be submitted on or before the 20th of the month following the quarter being reported.

Short Term Rental Tax Business ID. No.
For the Quarter Ending March June September December
Business Name (if applicable)
Last Name (if applicable)     First Name   
Mailing Address
City     State     Zip
Trade Name
Physical Address
City     State     Zip


1. Gross Receipts from All Rentals                                    
2. Gross Receipts from Short Term Rentals                        
3. Less Allowable Deductions (Attach List)                         
4. Balance (Taxable) (Line 2 Less 3)                                  
5. 1% Tax on Line 4                                                         
6. Penalty for Late Payment (10% of Line 5) ($10.00 min)    
7. Interest @ 10% per annum on Line 5 & 6                       
8. Total Tax, Penalty and Interest (Sum of 5, 6, & 7)       
                        

Method of Payment:
On-line (E-check)    (To pay on-line click  here.) 
By mail  (Make checks payable to: Treasurer, County of York) *

*Please Note: If submitting payment by mail, you must enclose a copy of this form as well as fill in the boxes below for the amount of payment enclosed and check #.

Amount of payment enclosed     Check #   


Declaration of Seller:
I hereby swear or affirm that the amounts listed are true, correct and complete to the best of my knowledge and belief for the period stated. By placing your initials in the appropriate box, it will be equivalent to your signature.

Taxpayer Initials     Date of Report


**This form and payment must be submitted on or before the 20th of the month following the quarter being reported.**

You may wish to print a copy for your records.

Please verify your information and