Monthly Utility Tax Return Form
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1CITY OF UNIVERSITY PLACE
3715 Bridgeport Way W.
Phone (253) 566-5656
University Place, WA 98466
Fax (253) 566-5658
Utility Tax Return
Month of _______________________, 20__________
Due on the last day of ___________________
(subsequent month)
Company:______________________________________________
Tax Type:
Cable
Cellular
Telephone
Address:_______________________________________________
Utility Occupation License Number:___________________________
City:____________________________
State:______
Zip:_____________
I. Gross Receipts for the month:
$
II. Deductions:
Amount
Deducted
Description
$_________________
__________________________________________________________________________
$_________________
__________________________________________________________________________
$_________________
__________________________________________________________________________
$_________________
TOTAL DEDUCTIONS
III. Taxable Income:
Gross Receipts from Line I
minus Total Deductions from Line II
$
Taxable Income
IV. Tax Due:
Taxable Income from Line III multiplied by 6.0% tax rate is tax due
________________________ * 6.0% =
$
Taxable Income Line III
Tax Due
$
V. Penalty and Interest Assessed:
(Late penalty up to 25%
plus interest may apply to
late returns.)
$
VI. Total Tax, Penalty & Interest:
I declare under penalty of perjury that this return (including any accompanying documentation) has been examined by me and to the best of my
knowledge and belief is a true, correct, and complete return.
Dated this ________________ day of _______________, 00_______
Authorized by ____________________________________________
Office or Title_____________________________________________
Phone Number____________________________________________
Returns may be submitted with payment either by mail at the address above or in person at the City's offices located at 3715 Bridgeport Way West
in the Windmill Village.
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4/10/20028:48 AM
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