Combined Excise Tax Return Form - May 2002 Page 2
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5IV 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
08
Motor Transportation; Railroad; Railroad Car
.01926
50
Urban Transportation; Vessels Under 65 ft
12
.00642
51
13
Other Public Service Business
.01926
** If taxable amounts on lines 45-51 column 3 total less than $2,000, no Public Utility Tax is due.
TOTAL STATE PUBLIC UTILITY TAX
VI OTHER TAXES
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
52
Tobacco Products
20
1.2942
53
Refuse Collection
64
.036
54
57
Temporarily Not Due - Fund Limit Reached
Petroleum Tax
.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
No.
Tax Classification
Code
Item
Quantity Sold
Rate
Tax Due
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):
59
State Enhanced 911 Tax
93
Number of Taxable Switched Access Lines:
.20
TOTAL OTHER TAXES
(Add lines 52-59)
PLEASE NOTE:
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
Amount
I.D.
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
High Technology Credit
County Sales and Use Tax Supplement, and other tax-related forms.
61
830
(attach Research & Development Credit Affidavit)
•
Under Tax Topics, click on BUSINESS for answers to frequently
Manufacturing Software; Programming Rural Employment
asked questions and business closure information. The
62
860
B&O Credit
Business Tax Guide link provides tax return information and
instructions, and the Filing Your Tax Return link provides
63
865
Help Desk Services B&O Credit
penalty waiver information.
64
875
•
Alternatives to Field Burning B&O Credit
To update your account information or to close your account with
the Department of Revenue, click on DOR SERVICES, then
65
855
International Services Credit
Business Information Update.
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.
Electric Utility Rural Economic Development Revolving Fund
67
870
•
To file a No Business Activity return by telephone, call (800) 647-7706.
Public Utility Tax Credit
Enter code 111 and follow these steps: 1) Enter your 9-digit
68
801
Bad Debt Tax Credit (attach Schedule B)
registration number; 2) Verify the number entered; 3) Enter 3;
4) Respond to pre-recorded questions to file your return over the
69
805
Hazardous Substance
telephone. Do not mail paper return back to the department.
Public Utility Tax Credit for Billing Discounts/Qualified Contributions
•
For penalty waiver criteria information, call (800) 334-8969 and
70
880
to a Low Income Home Energy Assistance Fund
enter code 429.
•
For business closure information, call (800) 334-8969 and
71
810
Other Credits (attach appropriate documents)
enter code 430.
TOTAL CREDIT (transfer to page 1, line 33)
For tax assistance, visit or call (800) 647-7706. To
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 MAY/02 (2-27-02)
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