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2. Monthly Hotel Occupation Tax
   City of Fremont 400 E. Military Fremont, NE 68025-5141
4. Company Name*
6. Address*
8. City*
9. State*
10. Zip*
12. Contact Person*
14. Phone*
15. Fax
17. Email*
18. Date*
20. Reporting Period*
    -- Select One --Jan 2023Feb 2023Mar 2023Apr 2023May 2023Jun 2023Jul 2023Aug 2023Sept 2023Oct 2023Nov 2023Dec 2023
22. Taxable Sales per FMC 14-111 thru 113*
23. Occupation Tax Rate
25. Occupation Tax Due*
27. Plus Interest Penalties per FMC 14-116*
28. Total Amount to be Remitted*
30. Taxes are delinquent after the 25th day of the next succeeding month.
32. Name and Title*
34. Do You Agree?*

    1. I Agree

    By clicking "I agree," you agree and acknowledge that 1) your application will not be "Signed" in the sense of a traditional paper document and 2) By signing in this alternate manner, you agree that your "electronic signature" is valid and binding upon you to the same force and effect as a handwritten signature.
36. Online payment will be available on Friday of every week.
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38. 1. Receive an email copy of this form.
39. Email address

    This field is not part of the form submission.

40. Submit

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