Lodger’s Tax Payment Form | Lincoln County New Mexico

Business/Lodge Name*

Certificate #*

Mailing Address*

Street Address Address Line 2 City State ZIP Code

Physical Address*

Same as Mailing Address

Street Address Address Line 2 City State ZIP Code

Current Date*

Report Month*

Report Year*

Hidden

Late Month Calc

Hidden

Late Month Jan to Sep

Hidden

Late Month Sept to Dec

Hidden

Late Month Dec

Hidden

Late Date

Gross Rent for Lodging*

Amounts received for rooms rented to vendees who have been a permanent resident of the premises for at least 30 consecutive days.*

Amounts received from room rent less than $2.00/day*

Total Gross Taxable Rent for Lodging*

Lodgers Tax Remitted (5% of Receipts)*

Hidden

10% of total

Late Fee $100

$100 or 10% of total, whichever is greater. Payment is Late as of .

Late Fee 10% of total

$100 or 10% of total, whichever is greater. Payment is Late as of .

Total

Total Rental Units in Facility:*

Number of Units Available per Month:*

Number of Times Units were Rented*

PENALTY FOR FAILURE TO MAKE PAYMENT OF TAX WHEN THIS REPORT IS DUE IS: The greater of 10% of the amount that was not duly remitted or $100.00. Under penalty of purjury, I declare that I have examined this report and to the best of my knowledge and belief it is true, correct and complete.

Signature

Name*

First Last

Title

Telephone

Email

After submitting this form you will be redirected to our payment processor to pay the amount: 1