Wyoming Lodging Tax                                    Wyoming Department of Revenue 
                                                                                  122 W 25th St, Suite E301 
                                                                                         Cheyenne, WY 82002
     Form 41-3             Supplement for Lodging Vendors

Please use black ink to complete form
Name                                                       Ownership RID: 
                                                           License Number: 
                                                           Report Period:        through 

Part IV - Lodging Tax Information - Do not use dollar signs, commas or periods
(Col 1)       (Col 2)      (Col 3)                                         (Col 4)
Jurisdiction
Name Code(Use Jurisdiction Lodging Tax Rate % in           Tax Due on Lodging Services
CAPS)         Digit Code   Effect in Jurisdiction

                                                          %

                                                          %

                                                          %

                                                          %

                                                          %

                                                          %

                                                          %

                                                          %

                                                          %

                                                          %

                                                          %

                                                          %

                                                          %

                                                          %

                                                          %

                                                          %

                                                          %

                                                          %

                                                          %

                                                          %
     Line 1. Total Tax on Lodging (Add totals in Column 4)
     Enter results here and on Part I, Line E of Form 41-1

                                                                                             Revised 1.23.2020