Local Public Utility Tax Return Form
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1CITY OF DUVALL
LOCAL PUBLIC UTILITY TAX RETURN
Collection for Period:___________________________________ Due:______________
Mail to:
City of Duvall
PO Box 1300
Duvall, WA 98019-1300
Company Name:_________________________________________
Address:________________________________________________
_________________________________________________
_________________________________________________
1. Gross Sales
$_______________________
2. Total Deductions
_______________________
3. Net Taxable Sales
_______________________
4. Tax Rate 6%
5. Tax Amount Due
$_______________________
I declare under penalty of perjury, that to the best of my knowledge and belief, the
statements herein and on attachments are true, correct and complete.
Name (Please print) ___________________________
Date
_______________
Signature
_________________________________
Title
_______________
Telephone
_________________________________
Fax
_______________
F:\everyone\forms\utiltax.doc
2/24/04
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