Fields marked with * are required. Before you can print the form, you must click calculate. If you have questions please contact the Commissioner of Revenue office at (540) 942-6610.

Name * Filing Month */Year *
Trade Name * Due Date * [mm/dd/yyyy]
Mailing Address * Filing Date * [mm/dd/yyyy]
City *
State *
Zip Code *
Definite Location
of business *
1. Gross rentals * $ (1.)
2. Allowable deductions:
a. Exempt rentals (over 30 days) $ (2a.)
b. Refund of Rentals included in line 1 of this report $ (2b.)
c. Refund of rentals included in prior reports $ (2c.)
d. Total deductions $ (2d.)
3. Item 1 less 2(d) $ (3.)
4. Tax (6% of Item 3) $ (4.)
5. Penalty for late payment (5% of item 4 or minimum of $2.00) $ (5.)
6. Interest (10% Annum) $ (6.)
7. Total tax, penalty and interest ( sum of items 4, 5, 6) $ (7.)
 


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