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2. Pursuant to City of Waukegan Ordinance #81-0-135
4. FOR:*
   (Month/Year)
6. NAME OF HOTEL/MOTEL:*
8. EXACT STREET ADDRESS:*
10. A. Total Revenue from Room Rentals for Calendar Month*
12. B. Less Permanent Residence Income*
14. C. Less Adjustments (attach itemized sheet)*
15. Itemized Sheet
17. D. Net Taxable Receipts*
19. E. 6% Tax Due*
21. F. Penalty (1% if filed after due date)*
23. G. Total Tax Due*
25. RHM-1
    Please Attach RHM-1
27. Tax is due on or before the last day of the succeeding month, i.e. January returns are due on or before the last day of February.
29. Failure to accurately and timely report Hotel/Motel Tax may result in penalties, including but not limited to fines and legal proceedings.
31. I hereby affirm that the statements herein contained are turn and correct to the best of my knowledge and belief:
33. Signature of Authorized Agent/Owner*
34. Print Name of Authorized Agent/Owner*
36. Signature of Tax Preparer*
37. Print Name & Title of Preparer*
39. Mailing Address of Preparer*
40. Telephone Number of Preparer*
42. Tax payment will be remitted via:*

    1. Mail - send to the City of Waukegan
    2. Epay

    Select one method of payment
43. The City of Waukegan
    Attn: Licensing Department 100 N. Martin Luther King Jr. Ave. Waukegan, IL. 60085 Telephone # 847-856-6425 Fax # 847-599-2584
44. Online Payment -
    E-Pay

    Link will open new window for online payment
Leave This Blank:


46. 1. Receive an email copy of this form.
47. Email address

    This field is not part of the form submission.

48. Submit

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