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                                                   CITY OF UNALASKA
                                             PO BOX 610 UNALASKA, AK 99685
                                           Phone (907) 581-1251     Fax (907) 581-1417 
                                                   www.ci.unalaska.ak.us

                                        MONTHLY PREPAYMENT FORM
                                                   HOTEL / MOTEL TAX 

                         YEAR:                                   MONTH:

                        QTR1 o          QTR2 o                   QTR3 o          QTR4 o
QTR ENDING
                      March 31          June 30                  September 30 December 31

NAME:                                                                         BUSINESS LIC. #
ADDRESS:

A.     DETERMINATION OF ADJUSTED GROSS RECEIPTS:
         1.     GROSS RECEIPTS FOR QUARTER (Including Hotel/Motel Tax collected)             $ ________________________
         2.     NON-TAXABLE RECEIPTS (Complete Page 2)                                       $ ________________________
         3.     ADJUSTED GROSS RECEIPTS (Subtract Line 2 from 1)                             $ ________________________

B.     DETERMINATION OF TAXABLE RECEIPTS:
         4.    DIVIDE LINE 3 BY 1.05 (TAXABLE GROSS RECEIPTS)                                $ ________________________

C.     DETERMINATION OF TAX DUE:
         5.     MULTIPLY AMOUNT OF LINE 4 BY .05 – HOTEL/MOTEL TAX DUE                       $ ________________________
         6.     DISCOUNT (If applicable, multiply Line 5 by .02)                             $ ________________________
         7.     NET PAYMENT DUE (Subtract Line 6 from Line 5)                                $ ________________________

To be eligible for the 2% discount, payment must be received at City Hall or postmarked on or before the 10th of the month 
following the month that receipts were received. This report must be filed for each month in  the quarter if discount is claimed 
for any month. Quarterly Hotel/Motel Tax Reports must be filed at the end of each month in addition to prepayment forms.

I CERTIFY THAT THE INFORMATION PROVIDED IS TRUE AND CORRECT.

SIGNATURE                                              TITLE                                 DATE

PRINTED NAME                                           EMAIL ADDRESS

COMPLETED HOTEL/MOTEL TAX REPORT MAY BE EMAILED TO CITY CLERK MARJIE VEEDER AT: mveeder@ci.unalaska.ak.us



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                                                                                                  Page 2 of 2
                                        CITY OF UNALASKA
                  PO BOX 610 UNALASKA, AK 99685
                  Phone (907) 581-1251     Fax (907) 581-1417 
                                        www.ci.unalaska.ak.us

                  MONTHLY PREPAYMENT FORM

                                        HOTEL/MOTEL TAX 

Name:                                                        Business License No. ____________________
Address:                                                                          Quarter Ending: ____________________
                                                             Due on or Before: ____________________

                  SUBSTANTIATION OF ALL NON-TAXABLE TRANSACTIONS

1.     SALES TO GOVERNMENT AGENCIES . . . . . . . . . . . . . . . . . . . . . . .        $ __________________________

         SOLD TO:                                                                          AMOUNT:

         ______________________________                                                    _________________________
         ______________________________                                                    _________________________
         ______________________________                                                    _________________________
         ______________________________                                                    _________________________

2.     ALL OTHER SALES CLAIMED EXEMPT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .        $ __________________________

         SOLD TO:          JUSTIFICATION FOR EXEMPTION:                                    AMOUNT:

         ______________________________         ______________________________          _________________________
         ______________________________         ______________________________          _________________________
         ______________________________         ______________________________          _________________________
         ______________________________         ______________________________          _________________________

TOTAL ALL NON-TAXABLE TRANSACTIONS      . . . . . . . . . . . . . .                 $ __________________________






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