Annual Utility Tax Return Form

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CITY OF UNIVERSITY PLACE
3715 Bridgeport Way W
Phone (253) 566-5656
University Place, WA 98466
Fax (253) 566-5658
Utility Tax Return
Annual Return (Note that you must receive first receive permission from
Due by January 31, 20_______
the City to file an annual return; returns are normally due on a monthly basis)
Company:__________________________________________
Address:___________________________________________________ Utility Occupation License Number:___________________________
City:____________________________
State:______
Zip:_____________
I. Gross Receipts for the year:
$
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 20%
plus interest may apply to
VI. Total Tax, Penalty & Interest:
late returns.)
$
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 _______________, 20_______
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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