Combined Excise Tax Return Form - February 2002
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5MAIL TO: State of Washington
Department of Revenue
FEBRUARY 2002
PO Box 34051
02
Seattle, WA 98124-1051
COMBINED EXCISE TAX RETURN
02
ONLY Fill in Box if Amended Return Information Attached
c
NAME
REG NO.
FIRM NAME
STREET ADDRESS
CITY, STATE, ZIP
Address Changes?
c
c
c
c
Business closed?
business location
mailing address
both
Date closed ____/____/____ See note section, pg 2.
I STATE BUSINESS AND OCCUPATION TAX
Please fill in the appropriate box and make address changes to the above label.
Line
Column I
Col. 2 Deductions*
Column 3
Col. 4
Column 5
Tax Classification
Code
No.
Gross Amount
Totals from Pg. 3 & 4
Taxable Amount
Rate
Tax Due
1
Extracting, Extracting for Hire
16
.00484
Slaughter, Break Proc, Perish Meat-Whlse; Mfg Wheat
2
30
.00138
into Flour; Raw Seafood; Soybean & Canola Proc
Travel Agent Com; Intl Charter Freight Brokers;
3
28
.00275
Stevedoring
4
Insurance Agents; Insurance Brokers Commis
14
.00484
Manuf Fresh Fruit and Veg; Split or Proc Dried Peas;
5
21
.00138
Prescription Drug Warehousing; Mfg Dairy Products
6
Processing for Hire; Printing and Publishing
10
.00484
7
Manufacturing
07
.00484
8
Royalties; Child Care
80
.00484
.00484
9
03
Wholesaling
Warehousing; Radio & TV Broadcasting; Public Road
10
11
.00484
Construction; Government Contracting
11
Public or Nonprofit Hospitals
55
.015
Cleanup of Radioactive Waste for US Gov’t;
12
83
.00471
Environmental Remedial Action
13
04
.015
Service & Other Activities
14
Retailing of Interstate Transportation Equip
19
.00484
15
Retailing
02
.00471
* Deductions taken but not itemized on pages 3 and 4 will be disallowed.
TOTAL B&O TAX
GROSS AMOUNTS FOR RETAILING AND
II STATE SALES AND USE TAX
RETAIL SALES MUST BE THE SAME
Retail Sales (also complete local tax section III)
16
01
.065
Value of articles used by taxpayer as a consumer
17
Use Tax (also complete local tax section III)
.065
05
on which no Washington sales tax has been paid
III LOCAL CITY AND/OR COUNTY SALES AND USE TAX
TOTAL STATE SALES & USE TAX
Local Sales Tax (Enter applicable rate of tax)
Code 45
MARCH 2002
DUE DATE: MARCH 25, 2002
Total Taxable Amount must be the same as line 16, column 3, Taxable Amount
S
M
T
W
T
F
S
25
«
5 % Penalty Assessed After March 25, 2002
Line
1
2
No. Location Code
Taxable Amount
Local Rate
Tax Due City or Co.
10% Penalty Assessed After April 30, 2002
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4
5
6
7
8
9
20% Penalty Assessed After May 31, 2002
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12
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14
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18
If the due date falls on a weekend or legal holiday, the
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23
19
due date is extended to the next business day.
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25
26
27
28
29
30
31
20
o
4 4
Please fill in this box if you had no business activity.
(see note section, page 2)
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This return must be mailed, unless filed electronically.
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4 4
Please make check or money order payable to the Washington State
TOTAL
Department of Revenue. Do not send cash or coins.
TOTAL
TAXABLE
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For assistance, call (800) 647-7706.
Local Use Tax (Enter applicable rate of tax)
Code 46
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Signature
Total Value of Articles must be the same as line 17, column 1, Gross Amount
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Ph. (
)
Line
Date
No. Location Code
Value of Articles
Local Rate Tax Due City or Co.
Line
Item
VIII TOTALS
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No.
24
Total All Tax Due from page 1
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25
30
Total All Tax Due from page 2
TOTAL VALUE
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Rental Car Tax (attach Rental Car Tax Addendum)
OF ARTICLES
TOTAL
Subtotal (add lines 29-31)
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Line
Tax
Code
Taxable Amount
Rate
Tax Due
No.
Classification
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Credit (from page 2, section VII, total credit)
Region Transit
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89
.004
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Subtotal (subtract line 33 from line 32)
Authority (RTA)
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Minimum
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Add Penalty, if applicable
King County
$5.00
27
90
.005
Food & Bev
Interest
36
28
Litter Tax
36
.00015
TOTAL AMOUNT OWED
(add lines 34 - 36)
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If you qualify, attach penalty waiver request and fill in box
c
(see note section, pg 2)
REV 40 2406 FEB/02 (1-14-02)
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