Hotel Tax Reg 2012

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					Newark
        2012 HOTEL TAX REGISTRATION FORM
Division of Tax Abatement and Special Taxes                                                    Date of Registration: _______________________
920 Broad Street, Room B-26
Newark, New Jersey 07102
Office 973-733-3770

        This registration form is to be completed by the Owner of the Parking Facility or authorized personnel for the Parking Facility

          PLEASE PRINT LEGIBLY OR TYPE ALL INFORMATION
Business Name: ____________________________________________                         Hotel License #: __________________________________

Corporation Name: _______________________________                                   Date Business Established: _____________________

Existing Owner: _______                 New Owner: __________


LOCATION OF BUSINESS FACILITY:                                                       MAILING ADDRESS FOR BUSINESS FACILITY:

Street: _______________________________________________________                      Street: ___________________________________________

City: _________________________ State: _______ Zip: _____________                    City: ___________________ State: ______ Zip: _________
                                                                                     _____________________
Block: _____________ Lot: __________ Qualifier:___________________
                                                                                     CONTACT INFORMATION:
Phone: _______________________________________________________
                                                                                     Primary Contact: ___________________________________
Fax: _________________________________________________________
                                                                                     Phone: ___________________ Mobile: _________________

                                                                                     E-Mail: ___________________________________________
TYPE OF ORGANIZATION:
Individual _____ Partnership ______ Corporation ______ LLC _______
                                                                                    Secondary Contact: _________________________________
Other (please specify) __________________________________________
                                                                                    Phone: ___________________ Mobile: _________________

                                                                                    E-Mail: ____________________________________________
FACILITY INFORMATION:                                                             RATES:
Number of Employees: ___________________________________________                  Single Rooms: ______ Double Rooms: ______ Suites: _____

Number of Rooms: ______ Single: ______ Double: _______ Suites: ______             Occupancy Rate: ___________________________________

Number of Other Locations: ________ Please Attach List on Separate Sheet Is Business Charging for Parking?             Yes        No
Paying Payroll Tax:   Yes       No                                                Daily: __________________          Hourly: ________________
If No Explain Reason: ___________________________________________
                                                                                  Is Business Paying Parking Tax?     Yes        No
Please Provide Tax Identification Number to which Payroll Taxes Are Being
Paid Under:                                                                       If Yes:

______________________________________________________________                    Please Provide Exact Location of Parking Lot:
                                                                                  ___________________________________________________

                                                                                  Please Provide Parking License Number:
                                                                                  ___________________________________________________

           CERTIFICATION: I CERTIFY THAT ALL THE INFORMATION GIVEN ON THIS REPORT IS ACCURATE AND CORRECT

           Completed By: Signature ________________________________________________________________________________

                            Printed   _______________________________________

                            Title: __________________________________________                 Date: ________________________________

				
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