Return For Occupation Tax - Utilities Form - Washington (Page 2 of 4) in pdf

Return For Occupation Tax - Utilities Form - Washington Page 2

Return for Occupation Tax – Utilities

Page 2

Itemization of deductions and exemptions claimed in No. 3 above:

Gross income derived within the City from transactions in

interstate commerce ................................................................................ $

Gross income derived within the City from transactions in

foreign commerce .................................................................................... $

Gross income derived within the City from business done for

the U.S. Government, its officers or agents, and paid by the

U.S. Government...................................................................................... $

Total amount paid to the City, the State of Washington, or the

United States as excise tax upon the sale or distribution of

property or services.................................................................................. $

Total amount deducted because of discounts allowed or

granted within the City ............................................................................. $

Amount or amounts paid to City as license fee or license fees

authorized as deductions by Kirkland Municipal Code

Sections 5.08.060(a) and 5.08.0601(c) ................................................... $

Total deductions from gross income (Enter here and in No. 4

above) ..................................................................................................... $

I, the undersigned, 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.

Signature

Date

Name and Title (Please Print)

Telephone Number

Fax Number

MMS\FI\BL\OC-TAX/12-11-01/FN:JS

Return For Occupation Tax - Utilities Form - Washington Page 2