CITY OF BELLINGHAM
TAX
Finance Department • City Hall • 210 Lottie Street • Bellingham, WA 98225
IS DUE:
• Phone (360) 778-8010 • Fax (360) 778-8001
BUSINESS AND OCCUPATION TAX RETURN
TAX PERIOD:
Enter Tax Year
Tax Period
BUSINESS REGISTRATION NO.
Business Name
Bus. Phone
Bus. Fax
Business Location
Start Date
Mailing Address
Description of Business
Ownership
E-mail Address
WA State UBI No.
Federal I.D. No.
UPDATE BELOW NAMES OF OWNERS, PARTNERS, OR CORPORATE OFFICERS - Attach additional page if necessary
Owner Name
Title
Phone
Home Address
Cell Phone
Owner Name
Title
Phone
Home Address
Cell Phone
PLEASE CALCULATE TOTAL TAX DUE BY ENTERING AMOUNTS IN BOXES BELOW:
(Instructions on reverse side)
TAX DEDUCTIONS
TAXABLE
TAX
BUSINESS
GROSS
LIQUOR,
OTHER
TAX DUE
CASH
BAD
RATE
RECEIPTS
AMOUNT
CLASSIFICATION
GAMBLING &
INTERSTATE
DEBTS
DISCOUNTS
GASOLINE SALES
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
.0017
EXTRACTING
1 2 3 4 5 6 7 8 9 0 1 2 3 4
1 2 3 4 5 6 7 8 9 0 1 2 3 4
1 2 3 4 5 6 7 8 9 0 1 2 3 4
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
1 2 3 4 5 6 7 8 9 0 1 2 3 4
MANUFACTURING
.0017
1 2 3 4 5 6 7 8 9 0 1 2 3 4
1 2 3 4 5 6 7 8 9 0 1 2 3 4
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
RETAILING
.0017
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
WHOLESALING
.0017
1 2 3 4 5 6 7 8 9 0 1 2 3 4
1 2 3 4 5 6 7 8 9 0 1 2 3 4
1 2 3 4 5 6 7 8 9 0 1 2 3 4
SERVICE &
1 2 3 4 5 6 7 8 9 0 1 2 3 4
.0044
$0.00
$0.00
$0.00
1 2 3 4 5 6 7 8 9 0 1 2 3 4
$0.00
$0.00
$0.00
$0.00
1 2 3 4 5 6 7 8 9 0 1 2 3 4
OTHER ACTIVITIES
1 2 3 4 5 6 7 8 9 0 1 2 3 4
1 2 3 4 5 6 7 8 9 0 1 2 3 4
❑
0.00
TOTAL TAX DUE THIS PERIOD
CHECK BOX IF MATC FORM ATTACHED
CREDIT AMOUNT $ ____________
Sold
Moved
Closed
Contact Info Changed
PENALTIES
Business was:
(SEE INSTRUCTIONS ON REVERSE SIDE)
Please Complete Change or Business Closure Section
PREVIOUS BALANCE
on reverse side of Form
TOTAL DUE
I certify, under penalty of perjury, that I have examined this return and any accompanying schedules and statements, and to the best of my
knowledge and belief, it is a true, correct and complete return.
Signature of Owner or Representative:
Title:
Date:
RETURN COMPLETED TAX RETURN TO ABOVE ADDRESS AND MAKE CHECK PAYABLE TO CITY OF BELLINGHAM