Quarterly Tax Report Form - Lacey, Washington
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1
2QTR / YEAR
LACEY TAX
DUE
TAX REPORT
NUMBER
DATE
QUARTERLY
420 COLLEGE ST SE
CHECK HERE IF NO INCOME TO REPORT.
LACEY, WA 98503-1238 (360) 491-3212
FILE BY DUE DATE TO AVOID
SUSPENSION/REVOCATION OF LICENSE AND
BUSINESS NAME_____________________________________________________
OTHER PENALTIES.
MAILING ADDRESS FOR TAX PURPOSES
STREET______________________________________________BOX___________
IF BUSINESS HAS BEEN SOLD OR
DISCONTINUED DURING THIS PERIOD,
CITY_______________________________STATE_______ZIP_________________
PLEASE COMPLETE THE FOLLOWING.
SOLD
DISCONTINUED
IN LACEY
BUSINESS AND OCCUPATION TAX
GROSS
NET
TAX
DATE_________________________________
DEDUCTIONS
TAX DUE
RECEIPTS
RECEIPTS
RATE
Retailing
.001
NEW OWNER__________________________
Contractors
.001
Services
.002
Printing
.001
AS THE OWNER/MANAGER OR AUTHORIZED
TOTAL
GROSS RECEIPTS: Do not include income from wholesale,
AGENT FOR THIS BUSINESS, I DECLARE THIS
TAX REPORT TO BE CORRECT.
manufacturing for wholesale, gambling income, or income from
activities not conducted in the City of Lacey.
TOTAL
If total NET RECEIPTS is below $5,000 per quarter, no tax is due,
DUE
however, the tax report MUST STILL BE FILED.
DATED THIS______ DAY OF __________, 20____
FIRM NAME_______________________________
DETAIL OF TAX DEDUCTIONS
Bad Debts
PRINTED NAME____________________________
MAKE CHECK PAYABLE
Cash Trade Discounts
TO THE CITY OF LACEY
PHONE___________________________________
Vehicle Fuel Sales
RETURN THIS PORTION WITH
SIGNATURE_______________________________
Liquor Sales
YOUR PAYMENT
Total Tax Deductions
QTR / YEAR
LACEY TAX
KEEP THIS PORTION FOR YOUR RECORDS
NUMBER
BUSINESS AND OCCUPATION TAX
GROSS
NET
TAX
DEDUCTIONS
TAX DUE
RECEIPTS
RECEIPTS
RATE
Retailing
.001
Contractors
.001
Services
.002
Printing
.001
DATE___________________
Penalties
CHECK #________________
Amount Paid to City of Lacey
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