Gross Receipt Rental Tax

Account ID

Remitting GRRT for year:
Ex: 2018, 2017, 2016, 2015, 2014, 2013, 2012, or prior

Property Owner's Name:

Street Address of Rental:

Phone:

Email:

Is mailing address on bill correct?

Yes No

Gross Rents Received During Period from all sources: Amount Required Is 5% Of Gross Rents Received

Payment Amount

Name on Card:

Mailing Address:

Address 2:

City:

State:

Zip:

Card Number:

Expiration:

Security Code:

Do you accept these terms?

I Accept I Don't Accept