STATUS [ ] For office use only

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1 CITY OF CHICAGO DEPARTMENT OF REVENUE HOTEL ACCOMMODATIONS TAX STATUS [ ] For office use only ACCOUNT NUMBER DUE DATE CHECK IF RETURN IS: Mail Payment and Return to: Amended BEGINNING PERIOD ENDING PERIOD MAILING ADDRESS: Number of Sites: BUSINESS ADDRESS: BUSINESS PHONE: Check the following if deposits were: Estimate Actual (If actual, annualization schedule must be attached) If you have any changes to the account information listed on this return please contact Client Consultation of the Department of Revenue at (312) 747-IRIS (4747). Do not fill in cents amount, round up to nearest dollar (if 50 cents or more). 1. Gross receipts from hotel accommodations (see instructions) Deductions (line 2f of instructions) Receipts subject to tax (subtract line 2 from line 1) Applicable tax rate... Tax due before current year's tax payments (multiply line 3 by line 4)... STOP AT LINE 5 IF THIS IS AN AMENDED RETURN Current year's tax payments Total tax due (subtract line 6 from line 5). If line 7 is greater than 0, enter the amount owed. If line 7 is less than 0, please skip to line Interest due for late payment (line 8c of instructions) Penalty due for late payment (see instructions)

2 REVISION NUMBER MARKING INSTRUCTIONS Use a black or blue ink pen only. Do not use pens with ink that soaks through the paper. Print clearly, using all CAPITAL letters. 10. Total tax, interest, and penalty due (add lines 7, 8, and 9) Overpayment. If line 7 is less than 0, enter the amount of overpayment. 12. If you want the amount of the overpayment to be credited to next year's estimated tax, enter a check in the Credit box. Otherwise, check the Refund box. Credit Refund NOTE: Any amounts overpaid will first be applied to deficiencies outstanding for this tax and to deficiencies for any other City of Chicago tax for which you are registered. Owner/Officer Statement Under penalty of perjury, I certify that I have examined this return, and to the best of my knowledge and belief, it is true, correct and complete. FIRST NAME LAST NAME PHONE NUMBER DATE SIGNATURE (REQUIRED) TITLE Preparer Statement Under penalty of perjury, I certify that I have examined this return, and to the best of my knowledge and belief, it is true, correct and complete. FIRST NAME LAST NAME PHONE NUMBER DATE AGENT/PAID PREPARER SIGNATURE (REQUIRED) BUSINESS NAME F.E.I.N. PHONE NOTE: YOU MUST FILL THIS FORM OUT COMPLETELY. IF ANY INFORMATION IS OMITTED, THIS RETURN WILL BE DEEMED INCOMPLETE, AND YOU WILL BE ASSESSED ADDITIONAL PENALTIES. ACCOUNT NUMBER MUST BE ENTERED. For DOR Use Only Postmark Date Receipt Number Page

3 INSTRUCTIONS FOR PREPARING THE HOTEL ACCOMMODATIONS TAX RETURN Line 1. Enter the gross receipts from hotel accommodations. This amount includes, but is not limited to, receipts from all sleeping, rooming, office, and conference rooms, exhibition halls, banquet and ballrooms, permanent resident rentals, state and municipal hotel taxes collected and/or other lease activities... NOTE: You have no obligation to collect this tax if you lease or rent six rooms or less Line 2. a. Enter total deductions below: Gross receipts from permanent residents. Applies only to individual using the room(s) as their domicile and permanent residence. You must maintain a permanent resident exemption certificate issued by the Chicago Department of Revenue for each guest for whom you are claiming the permanent resident exemption. If your business operates both as a Single Room Occupancy (SRO) and hotel the exemption certificates will have to be maintained for all permanent residence rooms... b. Chicago hotel accommodations tax collected... c. Enter all hotel taxes collected by you on behalf of the State of Illinois... d. Gross receipts from the Federal Government. All consideration must have been paid directly by the Federal Government... e. Other deductions (e.g., treaties)... f. Total deductions (add lines 2a through 2e)... Line 3. Line 4. Line 5. Line 6. Enter receipts subject to tax (subtract line 2f from line 1)... Preprinted tax rate. Tax due before current year's tax payments (multiply line 3 by line 4). Enter the total amount of all the current tax year's payments you have remitted to the Chicago Department of Revenue. Line 7. Enter total tax due (subtract line 6 from line 5). If line 7 is greater than 0, enter amount owed. If line 7 is less than 0, skip to line

4 Line 8. 8a. Determine the amount of interest owed based on tax past due. Enter number of days late (August 16 being one day late, etc.)... 8b. Enter the amount from line c. Total amount of interest (8b * [8a / 365]) * 12%... EXAMPLE: If you determine that you owe $100,000 on the due date (August 15) and you file and pay the tax on August 26, then you are 11 days late in making the payment. The calculation of the interest owed is as follows: [$100,000 * (11/365)] * 12% = $ Line 9. Line 10. Line 11. Line 12. Late penalties: Compute penalty based on 1 of the 2 requirements listed below: a) If the return is being filed timely, but payment is late, compute 5% of line 7. b) If the return is filed late, compute the greater of 1) 1% of line 5 (up to a maximum of $5,000) or 2) 5% of line 7. The tax return is due on or before the 15th day of the second month following the fiscal year in which taxable receipts are received. Enter the total tax. interest, and penalty due (add lines 7, 8, and 9). Overpayment. If line 7 is less than 0, enter the amount of overpayment. If you want the amount of overpayment to be credited to next year's estimated tax, enter a check in the credit box. Otherwise, check the refund box. NOTE: Any amounts overpaid will first be applied to deficiencies outstanding for this tax and to deficiencies for any other City of Chicago tax for which you are registered. FOR ADDITIONAL INFORMATION, CALL IRIS (4747) (TTY ) NOTE: YOU MUST COMPLETE ALL INFORMATION ON THIS PAGE FOR THIS RETURN TO BE CONSIDERED COMPLETE. Page

5 Chicago Department of Revenue Annualization Schedule ACCOUNT NUMBER TAX CODE BEGINNING PERIOD ENDING PERIOD Note: Please fill out this form if you meet at least one of the following criteria. 1. You paid or remitted at least $2 million dollars for any given tax type for the preceding annual tax year. 2. Your actual liability for this Annual Return Tax during any three consecutive calendar months of the twelve month period immediately preceding the current Annual Tax Year was greater than 50 percent of your liability for such Annual Return Tax for such entire twelve month period. 3. You are a new business that began after July 1st of the current tax year (an incomplete tax year). 4. You voluntarily elect to pay on an actual basis. 5. You did not remit one or more payment coupons or did not file a return in the twelve-month period immediately preceding the tax year now being filed. Tax Computed Due NOTE: DO NOT ENTER GROSS CHARGE/RECEIPT AMOUNTS. (Before any applicable commission) 1. July August September October November December January February March April May June... Total Tax Computed Due Before Any Applicable Commission. This amount must equal the tax due before commission reported on the tax return. Any difference will be applied to the earliest payment period. V

STATUS [ ] For office use only

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