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2. Please complete this return on or before the last day of each calendar month, for the reporting period of the preceding calendar month, per City Ordinance 3359. The tax is then due on or before the 15th of the next month. Please provide a copy of your State of Illinois Department of Revenue Hotel Operator's Occupation Tax Return with this form. Please remit to:

   City of Litchfield
   120 E Ryder Street
   Litchfield, IL 62056

4. Date submitted to City Clerk
   Date submitted to City Clerk
6. Filing Month

   1. January
   2. February
   3. March
   4. April
   5. May
   6. June

   1. July
   2. August
   3. September
   4. October
   5. November
   6. December
7. Year
9. Name of Business
11. Address of Business
13. Hotel/Motel Establishments

    Total Gross Receipts from rental of rooms exclusion of any tax

14. Deductions Authorized

    Receipts from  rooms rented to permanent residents of the establishment

16. Total Taxable Receipts

    Multiply taxable receipts by .04

17. Total Tax
19. Tax penalties or interest from previous months

    as per Ordinance 3359, Section I and J 

    (1.5% for each month or part of month)

    ($10 per day penalty for each day tax return is late)

20. Total Amount Hotel/Motel Tax Due

22. Under penalty, as provided by law, I declare that I have examined this return and accompanying schedules and to the best of my knowledge and believe, it is true, correct and taken from the books and records of the business for which this is filed.

24. Name of Taxpayer
26. Person Preparing Return
Leave This Blank:


28. 1. Receive an email copy of this form.
29. Email address

    This field is not part of the form submission.

30. Submit

* indicates a required field