Combined Excise Tax Return Form - May 2001 Page 4
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4Line 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
4904
Interstate & Foreign Sales
0204
4939
Amounts Paid to Another for Services Jointly Provided
Motor Vehicle Fuel Tax
0205
Amounts Expend. to Improve Consumer Efficiency
4942
Advances Reimbursements; Rtrns & Allowances
0207
Low Density/Wholesale Power Costs
4947
No Local Activity
0208
Other (Explain):
4999
Casual Sales; Accommodation Sales
0213
TOTAL
Tax in Gross
0214
Line 48 - Gas Distribution; Telegraph
I.D.
Amount
Consignment Sales
0215
2601
Bad Debts
Artistic/Cultural Activities
0216
Cash & Trade Discounts
2602
Presc. Drugs Sold by Pub. Oper/Nonprofit Hospitals
0217
Interstate & Foreign Sales
2604
Other (Explain):
0299
2639
Amounts Paid to Another for Services Jointly Provided
TOTAL
Other (Explain):
2699
Not all deductions are allowable from both
TOTAL
Retailing (B&O Tax) and Retail Sales Tax.
Line 49 - Motor Transportation; Railroad…
I.D.
Amount
Line 16 - Retail Sales Tax
I.D.
Amount
Bad Debts
0801
Bad Debts
0101
Cash & Trade Discounts
0802
Cash & Trade Discounts
0102
Interstate & Foreign Sales
0804
Interstate & Foreign Sales
0104
Amounts Paid to Another for Services Jointly Provided
0839
Tax in Gross
0114
Other (Explain):
0899
Sales to U.S. Government
0118
TOTAL
Motor Vehicle Fuel Sales
0119
Amount
Line 50 - Urban Transportation; Vessels…
I.D.
Prescription Drugs/Hearing Aids/Lenses/etc
0121
Bad Debts
1201
Exempt Food Sales
0122
Cash & Trade Discounts
1202
Qualified Nonresident Sales
0123
Interstate & Foreign Sales
1204
Amounts Paid to Another for Services Jointly Provided
1239
Trade-in Allowance
0124
Newspapers
0125
Other (Explain):
1299
Certain Network Telephone Service
0126
TOTAL
Line 51 - Other Public Service Business
I.D.
Amount
Sales to Indians with Delivery on the Reservation
0128
Bad Debts
1301
Sales of Feed to Fish Farmers
0129
Cash & Trade Discounts
1302
Taxable Amount for Tax Paid at Source
0130
Interstate & Foreign Sales
1304
Returns & Allowances
0131
Sales to Nonprofit Artistic/Cultural Art Objects for
1339
Amounts Paid to Another for Services Jointly Provided
0132
Displays
Other (Explain):
1399
Ride-Sharing Vans
0134
TOTAL
Purebred Livestock for Breeding
0135
Line 52 - Tobacco Products
I.D.
Amount
Tax Deferral/Investment Certificate No._________ 0136
Interstate & Foreign Sales
2004
Sale of Manufacturing Mach/Equip; Install Labor
0156
Sales to U.S. Government
2018
Other (Explain):
0199
Returned/Destroyed Goods
2043
TOTAL
Other (Explain):
2099
Line 45 - Water Distribution
I.D.
Amount
TOTAL
Bad Debts
6001
Line 53 - Refuse Collection
I.D.
Amount
Cash & Trade Discounts
6002
6401
Bad Debts
Interstate & Foreign Sales
6004
Sales to U.S. Government
6418
Amounts Paid to Another for Services Jointly Provided
6039
Sales to Other Refuse/Solid Waste Collectors
6445
Amounts Received by Nonprofit Water Association
6040
for Capital Projects
Other (Explain):
6499
Amounts Derived From Distribution of Water Through
6041
Irrigation Systems
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):
6599
Other (Explain):
6199
TOTAL
TOTAL
REV 40 2406 MAY/01 (2-28-01)
Page 4
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