Form 82 2090 - Tax Declaration For Cigarettes October 2004

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WARNING:
To protect against the possibility of others accessing your confidential
information, do not complete these forms on a public workstation.
Tax Declaration for Cigarettes
Reset This Form
Under state law, consumers are required to pay Washington taxes on cigarettes possessed in Washington. When you buy
from a retailer in Washington, the taxes have been paid (as evidenced by the Washington State cigarette tax stamp).
When you purchase cigarettes that do not bear the Washington State cigarette tax stamp, the cigarette tax and sales or use
tax must be declared and paid. Taxes must be paid within 72 hours of possession.
Step 1 – Enter your name and address (Use tab key to advance through form fields.)
Last Name (Please Print)
First
Middle Initial
Street Address (Include Apartment Number)
City
State
Zip Code
Telephone Number
Step 2 – Determine Location Code and Use Tax Rate
The rate of use tax is determined by the location where the item is first used in Washington. Normally, this will be the location of
your residence. Use the drop-down boxes below to select the city/county where you live. The location code and tax rate will
automatically fill in. If you have questions about this form or how to determine the location, please call 1-800-647-7706.
Select county where item is first
Select city where the item is first
Select County Here
Select City Here
used. Be sure to press tab or enter
used. If you do not live within the
after selecting county, in order to
Note: After selecting
city limits of a listed city, please
Note: After selecting
the county, press TAB
the city, press TAB or
bring up the correct list of cities:
select the unincorporated area:
or ENTER.
ENTER.
Step 3 –To calculate taxes due, please enter the number of cartons purchased on line 1. Press tab and enter total amount
paid for all cigarettes purchased on line 2. Press tab to complete line 2. Click on the calculate button, or press enter, and
lines 3 thru 6 should calculate automatically.
Value
1. Cigarette Tax: Number of cartons
X
$14.25
$
0.00
2. Total amount paid for all cigarettes (including Shipping & Handling) ....................
$
calculate
3. TOTAL (add lines 1 and 2).......................................................................................
=
$0.00
4. Use Tax Rate.............................................................. Location Code ___________
x
0.000
5. Use Tax Owed (multiply line 3 by line 4) ................................................................
=
$0.00
6. TOTAL TAX OWED - Cigarettes (total of lines 1 and 5).....................................
=
$0.00
To avoid duplicate billing, please list company name, month of purchase(s)
For Department Use Only
and invoice number(s) for purchases in the space provided below.
Fund No.
Amount
Company Name _________________________________________________
Use Tax
# 001 - 0199
Month of Purchase(s) _____________________________________________
Invoice number(s) _______________________________________________
General Fund
# 001 - 0125
Water Quality
Department of Revenue
Please mail this completed
# 139 - 0125
form along with your check to:
PO Box 47464
Drug Enforcement
Olympia, WA 98504-7464
# 181 - 0125
Health Care
Signature
# 760 - 0125
Date
I-773
# 760 - 0127
For tax assistance, visit or call 1-800-647-7706. To inquire about the availability of this
document in an alternate format for the visually impaired, please call (360) 486-2342. Teletype (TTY) users
please call 1-800-451-7985.
TOTAL
Print This Form
Make a Copy for Your Records
REV 82 2090 (10/1/04)

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