Combined Excise Tax Return Form - May 2002 Page 4

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Line 15 – Retailing (B&O)
I.D.
Amount
Line 47 – Power
I.D.
Amount
Bad Debts
0201
Bad Debts
4901
Cash & Trade Discounts
0202
Cash & Trade Discounts
4902
Interstate & Foreign Sales
0204
Interstate & Foreign Sales
4904
Motor Vehicle Fuel Tax
0205
Amounts Paid to Another for Services Jointly Provided
4939
Amounts Expend. to Improve Consumer’s Efficiency
Advances Reimbursements; Rtrns & Allowances
0207
4942
of Energy
No Local Activity
0208
Low Density/Wholesale Power Costs
4947
Casual Sales; Accommodation Sales
0213
Other (Explain):
4999
Tax in Gross
0214
TOTAL
Consignment Sales
0215
Line 48 - Gas Distribution; Telegraph
I.D.
Amount
Artistic/Cultural Activities
0216
Bad Debts
2601
0217
Presc. Drugs Sold by Pub. Oper/Nonprofit Hospitals
Cash & Trade Discounts
2602
Other (Explain):
0299
Interstate & Foreign Sales
2604
TOTAL
Amounts Paid to Another for Services Jointly Provided
2639
Not all deductions are allowable from both
Other (Explain):
2699
Retailing (B&O Tax) and Retail Sales Tax.
TOTAL
Line 16 - Retail Sales Tax
I.D.
Amount
Line 49 - Motor Transportation; Railroad…
I.D.
Amount
Bad Debts
0101
Bad Debts
0801
Cash & Trade Discounts
0102
Cash & Trade Discounts
0802
Interstate & Foreign Sales
0104
Interstate & Foreign Sales
0804
Tax in Gross
0114
Amounts Paid to Another for Services Jointly Provided
0839
Sales to U.S. Government
0118
Motor Vehicle Fuel Sales
0119
Other (Explain):
0899
Prescription Drugs/Hearing Aids/Lenses/etc
0121
TOTAL
Exempt Food Sales
0122
Line 50 - Urban Transportation; Vessels…
I.D.
Amount
Qualified Nonresident Sales
0123
Bad Debts
1201
Trade-in Allowance
0124
Cash & Trade Discounts
1202
Newspapers
0125
Interstate & Foreign Sales
1204
Certain Network Telephone Service
0126
Amounts Paid to Another for Services Jointly Provided
1239
Sales to Indians with Delivery on the Reservation
0128
Other (Explain):
1299
Sales of Feed to Fish Farmers
0129
TOTAL
Taxable Amount for Tax Paid at Source
0130
Returns & Allowances
0131
Line 51 - Other Public Service Business
I.D.
Amount
Sales to Nonprofit Organizations of Artistic/Cultural Art
Bad Debts
1301
0132
Objects for Displays
Cash & Trade Discounts
1302
Ride-Sharing Vans
0134
Purebred Livestock for Breeding
0135
Interstate & Foreign Sales
1304
Tax Deferral/Investment Certificate No.
0136
1339
Amounts Paid to Another for Services Jointly Provided
Sale of Manufacturing Mach/Equip; Install Labor
0156
Other (Explain):
1399
Direct Pay Permits
0170
TOTAL
Other (Explain):
0199
Line 52 - Tobacco Products
I.D.
Amount
TOTAL
Interstate & Foreign Sales
2004
Line 45 - Water Distribution
I.D.
Amount
Sales to U.S. Government
2018
Bad Debts
6001
Returned/Destroyed Goods
2043
Cash & Trade Discounts
6002
Other (Explain):
2099
Interstate & Foreign Sales
6004
TOTAL
6039
Amounts Paid to Another for Services Jointly Provided
Line 53 - Refuse Collection
I.D.
Amount
Amounts Received by Nonprofit Water Association
6040
for Capital Projects
Bad Debts
6401
Amounts Derived From Distribution of Water
Sales to U.S. Government
6418
6041
Through Irrigation Systems
Sales to Other Refuse/Solid Waste Collectors
6445
6057
Conservation Expenditures
Other (Explain):
6499
6058
Reclaimed Water
TOTAL
Other (Explain):
6099
Line 54 - Petroleum Tax
I.D.
Amount
TOTAL
Petroleum Products Exported Out of State
5746
Line 46 - Sewer Collection
I.D.
Amount
Other (Explain):
5799
Bad Debts
6101
TOTAL
Cash & Trade Discounts
6102
Line 55 - Hazardous Substance
I.D.
Amount
Amounts Paid to Another for Services Jointly Provided
6139
Other (Explain):
6199
Other (Explain):
6599
TOTAL
TOTAL
REV 40 2406 MAY/02 (2-27-02)
4

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