Combined Excise Tax Return Form - Washington State Department Of Revenue - 2013
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4MAIL TO: Washington State
Jan - Dec 2013
Department of Revenue
A
PO Box 47464
Olympia WA 98504-7464
13
Combined Excise Tax Return
If you had no business activity, check the box and mail this return
(unless filed electronically)
NAME
TAX REG NO.
BUSINESS NAME
STREET ADDRESS
CITY, STATE, ZIP
Address Changes?
Business Location
Mailing Address
Business Closed?
Other Correspondence?
Date Closed ___/___/___ See Additional Information, pg 2
Effective date of change ___/___/___
Please fill in the appropriate box and note address changes above.
Use Black Ink & Return The Original Form
I STATE BUSINESS AND OCCUPATION TAX
Line
Column I
Col. 2 Deductions*
Column 3
Col. 4
Column 5
Tax Classification
Code
No.
Gross Amount
Totals from Pg. 3 & 4
Taxable Amount
Rate
Tax Due
1
Extracting, Extracting for Hire
16
.00484
Slaughter, Break Proc, Perish Meat-Whlse; Mfg Wheat
2
30
.00138
into Flour; Soybean & Canola Proc
Travel Agent Com/Tour Operators; Intl Charter Freight
3
28
.00275
Brokers; Stevedoring; Assisted Living Facilities
Insurance Producers; Title Insurance Agents;
4
14
.00484
Surplus Line Broker Commissions
Prescription Drug Warehousing; Mfg: Wood Biomass
5
21
.00138
Fuel; or Split/Proc Dried Peas
6
10
Processing for Hire; Printing and Publishing
.00484
7
07
Manufacturing
.00484
8
80
Royalties; Child Care
.00484
9
03
Wholesaling
.00484
Warehousing; Radio & TV Broadcasting; Public Rd Const; Gov
10
11
.00484
Contracting; Chem Dependency Ctr; Canned Salmon Labelers
11
55
Public or Nonprofit Hospitals; Qualified Food Co-ops
.015
Cleanup of Radioactive Waste for US Gov
12
83
.00471
Income from
Service & Other Activities and/or
704
13a
.018
Jan-June only
13
Gambling Contests of Chance
Income from
04
(less than $50,000 a year)
13b
.015
July-Dec only
Income from
792
14a
.0193
Jan-June only
Gambling Contests of Chance
14
($50,000 a year or greater)
Income from
192
14b
.0163
July-Dec only
15
135
For Profit Hospitals; Scientific R&D
.015
16
19
Retailing of Interstate Transportation Equip
.00484
17
Retailing
02
.00471
* Deductions taken but not itemized on pages 3 and 4 will be disallowed.
GROSS AMOUNTS FOR RETAILING AND
TOTAL B&O TAX
RETAIL SALES MUST BE THE SAME
II STATE SALES AND USE TAX
18
01
Retail Sales (also complete local tax section III)
.065
Value of articles used by taxpayer as a consumer
Use Tax/Deferred Sales Tax (also complete local use
19
05
.065
on which no Washington sales tax has been paid
tax section III)
TOTAL STATE SALES & USE TAX
III LOCAL CITY AND/OR COUNTY SALES AND USE TAX
Local Sales Tax (Enter applicable rate of tax.)
Code 45
Filing an Amended Return?
Check this box and attach a letter of explanation.
Total Taxable Amount must be the same as line 18, column 3, Taxable Amount
DUE DATE: January 31, 2014
Line
Location Code
Taxable Amount
Local Rate
Tax Due City or Co.
No.
5% Penalty Assessed After January 31, 2014
20
15% Penalty Assessed After February 28, 2014
25% Penalty Assessed After March 31, 2014
21
If the due date falls on a weekend or legal holiday,
22
the due date is extended to the next business day.
23
Signature
TOTAL
TOTAL
TAXABLE
Print Name
Ph. (
)
Date
Local Use Tax/Deferred Sales Tax (Enter applicable rate of tax.) Code 46
Line
Total Value of Articles must be the same as line 19, column 1, Gross Amount
Item
VII TOTALS
No.
Line
Location Code
Value of Articles
Local Rate
Tax Due City or Co.
No.
28
Total All Tax Due from page 1
24
29
Total All Tax Due from page 2
25
30
Total All Addendums (example: Rental Car Addendum)
TOTAL VALUE
TOTAL
31
Subtotal (add lines 28-30)
OF ARTICLES
32
Credit (from page 2, section VI, total credit)
Line
Tax
33
Subtotal (subtract line 32 from line 31)
Code
Taxable Amount
Rate
Tax Due
No.
Classification
34
Add Penalty, if applicable
Minimum $5.00
Motor Vehicle
26
120
.003
Sales/Leases
TOTAL AMOUNT OWED (add lines 33 - 34)
27
Litter Tax
36
.00015
Please make check or money order payable to the Washington State Department of
Revenue. Include your tax registration number on your check.
Internet/Fax
(10-30-13
Penalty waiver request? Check this box and attach a letter of explanation.
)
Page 1
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