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Hotel-Occupancy-Tax-Return VILLAGE OF OAK BROOK HOTEL OCCUPANCY TAX RETURN For Month Ending Statement of Tax Receipts under the provisions of Ordinance G-817 of the Municipal Code of the Village of Oak Brook. Name of Hotel Address Name of Operator COMPUTATION OF TAX: 1. Gross Room Rental Receipts $ a. Less: Exempted Rental Receipts $ b. Subtotal: Net Receipts $ 2. Tax – 3% of Line 1b $ Remittances are required monthly. Taxes must be paid on or before the 30th of the following month for which the return is being filed. Make check payable to: VILLAGE OF OAK BROOK ALL FIGURES ARE SUBJECT TO AUDIT ______________________________________________________________________ I hereby affirm that the statements herein contained are taken from the books and records of the above listed establishment and are true and correct to the best of my knowledge. Return Original with Remittance to: Date Village of Oak Brook Attn: Finance Dept. Signature 1200 Oak Brook Rd. Oak Brook, IL. 60523 Name For inquiries please call the Village of Oak Brook at (630) 368-5000. Title