Utility Tax Return Report Form Mukilteo Washington

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CITY OF MUKILTEO
4480 CHENNAULT BEACH ROAD
MUKILTEO, WA 98275
(425) 355-4141
UTILITY TAX RETURN REPORT
PERIOD COVERED:_______________________________________
Utility Company Name:
_______________________________________________________________
Address:
_______________________________________________________________
City, State, Zip:
_______________________________________________________________
Website & Phone #
_______________________________________________________________
Business Activity:
Cable Television
Garbage Collection
Telephone/
Wireless
Storm Drain
Electricity
Natural Gas
1.
Gross Revenue
_________________________________________________
2.
Deductions
_________________________________________________
3.
Taxable Revenue
_________________________________________________
4.
Tax (Line 3 times 6%)
_________________________________________________
5.
Penalty
_________________________________________________
6.
TOTAL TAX DUE
_________________________________________________
(Tax is due on the last day of each calendar quarter, or on the last day of each month.)
I hereby certify that the statements and information furnished on this report are true and
complete to the best of my knowledge.
____________________________________________
____________________________
Owner/Representative Signature
Date
____________________________________________
____________________________
Name (please print)
Telephone Number
______________________________________________________________________________
Name and Address of Utility Tax Preparer if other than Utility Company
UTILTAX2.doc09/25/06

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