Business And Occupation Tax Return Form
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1Send Payments To:
City of Pacific,
100 3rd Ave SE
CITY OF PACIFIC, WASHINGTON
Pacific, WA 98047
BUSINESS AND OCCUPATION TAX RETURN
Tax Period ____________________
(Quarter & Year)
BUSINESS REGISTRATION NO: _________________
WA STATE UBI #
SIC #
__________________________________
Business Name
Business Phone
Business Location
Business Fax
Mailing Address
Business Type
(Indicate all that apply:Extracting, Manufacturing,Retail, Wholesale,Service & Other)
Owner Name and Title
Description of Business
Owner Phone
__________________________________
PLEASE CALCULATE TOTAL TAX DUE BY ENTERING AMOUNTS IN BOXES BELOW: (
See nstructions)
BUSINESS
EXEMPTIONS OR
CLASSIFICATION
GROSS RECEIPTS
DEDUCTIONS (specify)
TAXABLE AMOUNT
RATE
TAX DUE
EXTRACTING
0.002
0.002
MANUFACTURING
0.002
RETAILING
0.002
WHOLESALING
SERVICE & OTHER
0.002
ACTIVITIES
Penalties (if applicable)
TAX DUE THIS PERIOD
$5 or 5% of the tax due (whichever is greater) if not received on or before due date
PENALTIES
$5 or 15% of the tax due (whichever is greater) if received after the
TOTAL DUE
last day of the first month following the due date.
$5 or 25% of the tax due (whichever is greater) if received after the
last day of the 2nd month following the due date.
I certify, under penalty of perjury, that I have examined this return and any accompanying schedules and statements,
and to the best of my knowledge and belief, it is a true, correct and complete return.
Signature of Owner or Representative___________________
Title _______________________
Date __________
SEND COMPLETED TAX RETURN TO ABOVE ADDRESS AND MAKE CHECK PAYABLE TO CITY OF PACIFIC
If business closed or ownership change please indicate:
Date Closed
New owner name
_____________________________
New owner address _____________________________
Internal use only
Form Revised December 2008
Receipted ________
Posted
________
Audited
________
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