For the Month of __________________________________, _______________

BUSINESS NAME (if operated at such): ___________________________________________________

NAME OF OWNER:                __________________________________________________________

MAILING ADDRESS:              __________________________________________________________

                              __________________________________________________________

                              __________________________________________________________




	
Computation of Occupancy Tax
	
Watauga
	
Avery


	
6% of Gross Rec.
	
6% of Gross Rec.


	
1. Gross Retail Receipts (excludes any tax)
	
$
	
$


	
2. Less: Non-occupancy Related Receipts
	
$
	
$


	
3. Less: Occupancy Receipts Not Subject to Sales Tax
	
$
	
$


	
4. Less: Occupancy Receipts After 90th Consecutive Day
	
$
	
$


	
5. Credits on Previously Charged Exempt Receipts
	
$
	
$


	
6. Net Retail Receipts
	
$
	
$


	
Total of Occupancy Tax Due
	
$
	
$


	
7. Total Tax (6% of Line 6)
	
$
	
$


	
8. Discount - Less: 3% of Tax Due (if filed on time)
	
$
	
$


	
9. Penalty
	
$
	
$


	
10. Total Amount Due
	
$
	
$


	
11. Total Amount Remitted (total of Line 10)
	
$
	
$



Certification: This is to certify that this report, including all statements and
schedules attached hereto, 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 named above
and that the same is in accordance with the records of the reporting taxpayer.


_______________________________________________________         __________________________
Signature                                                       Date