Combined Excise Tax Return Form - Jan - Dec 2001 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
Location Code
Taxable Amount
Rate
Tax Due
Location Code
Taxable Amount
Rate
Tax Due
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
No.
Tax Classification
Code
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
Motor Transportation; Railroad; Railroad Car
08
.01926
Urban Transportation; Vessels Under 65 ft
.00642
50
12
51
Other Public Service Business
13
.01926
** If taxable amounts on lines 45-51 column 3 total less than $24,000, 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
No.
Tax Classification
Code
Gross Amount
Totals from Pg. 4
Taxable Amount
Rate
Tax Due
Tobacco Products
.7490
52
20
Refuse Collection
.036
53
64
54
Petroleum Tax
57
.005
Temporarily Not Due - Fund Limit Reached
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
Tax Classification
Code
Item
Quantity Sold
Rate
Tax Due
No.
Number of Stoves, Fireplaces, & Solid Fuel
$30.00
57
59
Solid Fuel Burning Device Fee
Burning Devices:
$1.00
58
54
Syrup Tax
Number of Gallons:
.20
59
93
State Enhanced 911 Tax
Number of Taxable Switched Access Lines:
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
No.
I.D.
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
County Sales and Use Tax Supplement, and other tax-related forms.
High Technology Credit
61
830
•
(attach Research & Development Credit Affidavit)
Under Tax Topics, click on BUSINESS for answers to frequently
asked questions and business closure information. The Business
Manufacturing Software/Programming Rural
62
860
Tax Guide link provides tax return information and instructions, and
Employment B&O Credit
the Filing Your Tax Return link provides penalty waiver information.
63
865
Help Desk Services B&O Credit
•
To update your account information or to close your account with
the Department of Revenue, click on DOR SERVICES, then
64
Alternatives to Field Burning B&O Credit
875
Business Information Update.
Telephone Assistance
65
855
International Services Credit
•
Call the Department of Revenue office nearest you or (800) 647-
Small Business B&O Tax Credit (see table enclosed)
66
815
7706.
•
Electric Utility Rural Economic Development Revolving
To file a No Business Activity return by telephone, call (800) 647-
67
870
Fund Public Utility Tax Credit
7706. Enter code 111 and follow these steps: 1) Enter your 9-digit
registration number; 2) Verify the number entered; 3) Enter 3;
68
801
Bad Debt Tax Credit (attach Schedule B)
4) Respond to pre-recorded questions to file your return over the
telephone. Do not mail paper return back to the department.
69
805
Hazardous Substance
•
For penalty waiver criteria information, call (800) 334-8969 and enter
Public Utility Tax Credit for Billing Discounts/Qualified Contri-
code 429.
70
880
butions to a Low Income Home Energy Assistance Fund
•
For business closure information, call (800) 334-8969 and enter
code 430.
71
810
Other Credits (attach appropriate documents)
To inquire about the availability of this form in an alternate format for the
TOTAL CREDIT (Transfer to page 1, line 33)
visually impaired, please call (360) 486-2342. Teletype (TTY) users may
call (800) 451-7985.
REV 40 2406 A01 (10-31-01)
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