Combined Excise Tax Return Form - January 2002 Page 2

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IV LODGING TAXES
TRANSIENT RENTAL INCOME INFORMATION
(enter location code and income only)
Code 47
Line
Location Code
Income
Location Code
Income
Location Code
Income
No.
37
38
CONVENTION AND TRADE CENTER TAX
SPECIAL HOTEL/MOTEL TAX
Code 48
Code 70
Line
Line
Taxable Amount
Rate
Tax Due
Location Code
Taxable Amount
Rate
Tax Due
Location Code
No.
No.
39
42
40
43
41
44
TOTAL CONVENTION & TRADE CENTER TAX
TOTAL SPECIAL HOTEL/MOTEL TAX
V STATE PUBLIC UTILITY TAX
Line
Column I
Col. 2 Deductions*
Column 3**
Col. 4
Column 5
Tax Classification
Code
No.
Gross Amount
Totals from Pg. 4
Taxable Amount
Rate
Tax Due
45
Water Distribution
60
.05029
46
Sewer Collection
61
.03852
47
Power
49
.03873
48
Gas Distribution; Telegraph
26
.03852
49
Motor Transportation; Railroad; Railroad Car
08
.01926
50
Urban Transportation; Vessels Under 65 ft
12
.00642
51
Other Public Service Business
13
.01926
TOTAL STATE PUBLIC UTILITY TAX
** If taxable amounts on lines 45-51 column 3 total less than $2,000, no Public Utility Tax is due.
VI OTHER TAXES
Line
Column I
Col. 2 Deductions*
Column 3
Col. 4
Column 5
No.
Tax Classification
Code
Gross Amount
Totals from Pg. 4
Taxable Amount
Rate
Tax Due
52
Tobacco Products
20
1.2942
53
Refuse Collection
64
.036
Temporarily Not Due - Fund Limit Reached
54
Petroleum Tax
57
.005
55
Hazardous Substance
65
.007
Intermediate Care Facilities for the
56
79
.06
Mentally Retarded (IMR)
* Deductions taken but not itemized on page 4 will be disallowed.
Line
Tax Classification
Code
Item
Quantity Sold
Rate
Tax Due
No.
Number of Stoves, Fireplaces, & Solid
57
Solid Fuel Burning Device Fee
59
$30.00
Fuel Burning Devices:
Number of Gallons
58
Syrup Tax
54
$1.00
(whole numbers only):
State Enhanced 911 Tax
Number of Taxable Switched Access Lines:
.20
59
93
TOTAL OTHER TAXES
PLEASE NOTE:
(Add lines 52-59)
If you do not have deductions, do not return pages 3 and 4.
VII CREDITS
If you have deductions, complete and return pages 3 and 4.
Line
Credit
NEED HELP?
Credit Classification
I.D.
Amount
No.
Internet Assistance – Go to DOR’s home page at
60
800
Multiple Activities Tax Credit (attach Schedule C)
•
Click on FORMS to access forms including the Local City and/or
County Sales and Use Tax Supplement, and other tax-related forms.
High Technology Credit
61
830
•
Under Tax Topics, click on BUSINESS for answers to frequently
(attach Research & Development Credit Affidavit)
asked questions and business closure information. The
Manufacturing Software; Programming Rural Employment
Business Tax Guide link provides tax return information and
62
860
B&O Credit
instructions, and the Filing Your Tax Return link provides
63
865
Help Desk Services B&O Credit
penalty waiver information.
•
To update your account information or to close your account with
64
Alternatives to Field Burning B&O Credit
875
the Department of Revenue, click on DOR SERVICES, then
Business Information Update.
65
855
International Services Credit
Telephone Assistance
66
815
Small Business B&O Tax Credit (see table enclosed)
•
Call the Department of Revenue office nearest you or (800) 647-7706.
•
To file a No Business Activity return by telephone, call (800) 647-7706.
Electric Utility Rural Economic Development Revolving Fund
67
870
Enter code 111 and follow these steps: 1) Enter your 9-digit
Public Utility Tax Credit
registration number; 2) Verify the number entered; 3) Enter 3;
68
801
Bad Debt Tax Credit (attach Schedule B)
4) Respond to pre-recorded questions to file your return over the
telephone. Do not mail paper return back to the department.
69
Hazardous Substance
805
•
For penalty waiver criteria information, call (800) 334-8969 and
Public Utility Tax Credit for Billing Discounts/Qualified Contributions
enter code 429.
70
880
to a Low Income Home Energy Assistance Fund
•
For business closure information, call (800) 334-8969 and
enter code 430.
71
Other Credits (attach appropriate documents)
810
For tax assistance visit or call 1-800-647-7706. To
TOTAL CREDIT (transfer to page 1, line 33)
inquire about the availability of this document in an alternate format for
the visually impaired, please call (360) 486-2342. Teletype (TTY)
users may call (800) 451-7985.
REV 40 2406 JAN/02 (12-21-01)
2

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