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2. Trade Name*
4. Address1*
6. Address2
8. City*
9. State*
10. Zip*
12. Contact Name*
14. Contact Number:*
16. 1. Gross Room Rental Receipts*
    Enter gross room rental receipts derived from the rental of any room, lodging, or similar accommodation furnished by a hotel, motel, inn, or similar place within the corporate limits of the City of Jacksonville that is subject to sales tax imposed by the State of North Carolina under G.S. 105-164.4 (a)(3).
18. 2. Less Section 27 Exempt Receipts
    Enter the total of Exempt Receipts as provided for in the NC Department of Revenue Sales & Use Tax Technical Bulletin Section 27.* This tax was levied by the City Council of Jacksonville March 2, 2010, effective July 1, 2010, in accordance with Senate Bill 80 of the 2009 Session of the NC General Assembly. This includes rentals to the person, not the same company, for 90 continuous days. For refunds of tax collected previously for the rental to the same person, contact the City of Jacksonville. * (The most recent Sales & Use Tax Technical Bulletins can be found at the NC Department of Revenue website (http://www.dornc.com/practitioner/sales/bulletins/toc.html))
20. 3. Less Section 37 US Government Receipts
    Enter the total of Exempt Receipts as provided for in the NC Department of Revenue Sales & Use Tax Technical Bulletin Section 35* which details sales to US Government. Sales must be documented to have been paid for as provided for in the Bulletin.
22. 4. Total Exempt Sales (Lines 2 + 3)
    Total Lines #2 and #3 to determine amount of exempt receipts.
24. 5. Taxable Gross Receipts (Line 1 less Line 4)*
    Subtract Line #4 from Line #1 to determine Taxable Gross Receipts
26. 6. Computation of tax (3% of line 5)*
    Enter 3% of the Taxable Gross Receipts.
28. 7. Eligible Refund (must be pre-authorized by the City)
    Enter pre-authorized refunds as provided for in instructions by the City of Jacksonville. You may be required to submit folio.
30. 8. Penalities, if any
    If the tax is not paid by the due date, add a penalty equal to ten percent (10%) of the tax. If the return is more than thirty (30) days late, an additional tax of five percent (5%) of the tax due should be added for each thirty (30) days, or fraction thereof.
32. 9. Total tax and penalties to be remitted payable to City of Jacksonville (Line 6, less line 7, plus line 8)*
    This report and total amount due must be remitted by check or money order and in the office of the City of Jacksonville Finance Director by the 20th day following the last day of the month for which the Tax was collected.
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