Combined Excise Tax Return Form - May 2002 Page 5

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SUPPLEMENT FORM 40 2406
State of Washington
Use this form if space on page 1 FORM 40 2406 is not sufficient
Department of Revenue
Period
Year
PO Box 47476
2002
LOCAL CITY AND/OR COUNTY SALES AND USE TAX
02
Olympia WA 98504-7476
Name
Tax Reporting Account No.
If you have business activity in more than one location, use the space below to show
breakdown of income by city or county. Group sales tax and use tax separately.
SALES TAX [45]
USE TAX [46]
City or
Rate
Tax Due
City or
Rate
Tax Due
Taxable Amount
Taxable Amount
County
of Tax
City or County
County
of Tax
City or County
Code
Code
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
Total Same as Line 16, Col 3, Pg. 1
Add Total Sales Tax Due
Total Same as Line 17, Col 1, Pg. 1
Add Total Use Tax Due
For tax assistance visit or call (800) 647-7706. To inquire about the availability of this form in an alternate format for the
visually impaired, please call (360) 486-2342. Teletype users may call (800) 451-7985.
REV 40 0015e (1-01-02)
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