Form A-10 - Business & Occupation Activities Return - 2010
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1
2
3
4
5January - December 2010
Mail to:
State of Washington
A
10
Department of Revenue
Business & Occupation Activities Return
PO Box 34051
Seattle, WA 98124-1051
Tax Registration Number
Use Black Ink &
4
Name
Return Original Form.
Business Name
Street Address
City, State, Zip
Filing an Amended Return?
Has Your Address Changed?
Business Closed?
If so, check appropriate box(es) below and note changes on address above.
Check this box and attach amended return
Check this box and enter date closed.
information and a letter of explanation.
Business Location Change
Mailing Address Change
Other Correspondence?
I. State Business and Occupation (B&O) Tax
Travel Agent Comm/Tour Operator; Intl Charter Freight Brokers; Stevedoring; Licensed Boarding Homes [28]
Gross Amount
Taxable Amount
Tax Due
Deductions*
Rate
,
,
,
,
.
,
,
,
.
.
.
X
-
=
1.
.00275
Insurance Producers; Title Insurance Agents; Surplus Line Broker Commissions [14]
Gross Amount
Taxable Amount
Tax Due
Deductions*
Rate
,
,
,
,
,
,
.
.
,
.
.
X
-
=
2.
.00484
Royalties; Child Care [80]
Gross Amount
Taxable Amount
Tax Due
Deductions*
Rate
,
,
,
,
,
,
.
.
,
.
.
X
-
=
3.
.00484
Wholesaling [03]
Gross Amount
Taxable Amount
Tax Due
Deductions*
Rate
,
,
,
,
,
,
.
.
,
.
.
X
-
=
4.
.00484
For Profit Hospitals; Scientific R&D [135] (May - Dec income only)
Gross Amount
Deductions*
Taxable Amount
Rate
Tax Due
,
,
,
,
,
,
.
.
,
.
.
X
-
=
5.
.015
Service & Other Activities [04] (Jan - April income only)
Gross Amount
Taxable Amount
Tax Due
Deductions*
Rate
,
,
,
,
,
,
.
.
,
.
.
X
-
=
6.
.015
Service & Other Activities [504] (May - Dec income only)
Gross Amount
Taxable Amount
Tax Due
Deductions*
Rate
,
,
,
,
.
,
,
,
.
.
.
X
-
=
7.
.018
*
Deductions taken but not itemized on pages 3 & 4 will be disallowed.
State and Local Use Tax/Deferred Sales Tax (See page 2.)
4
DUE DATE: January 31, 2011
IV. Totals
* 5% Penalty Assessed After January 31, 2011
,
,
.
21. Total Tax Due from Section I
15% Penalty Assessed After February 28, 2011
(Tax due from lines 1-7)
25% Penalty Assessed After March 31, 2011
If the due date falls on a weekend or legal holiday,
,
,
.
22. Total Tax Due from Section II
the due date is extended to the next business day.
(Tax due from line 13)
No Business Activity?
23. Total All Addendums
,
(Example:
,
.
File by telephone: Call 1-800-647-7706.
Local Sales/Use Tax)
At the greeting, enter code 111 to start the process. Enter your 9-digit
tax registration number and follow the instructions given. If you file by
,
,
.
24. Subtotal
telephone, do not mail us your return; or
(add lines 21-23)
If you have no business activity and did not file by telephone, check this
,
,
.
25. Total Credit from Section III
box, sign and mail us your return.
(from page 2, line 20)
4
Make check or money order payable to the Washington State Department
of Revenue. Include your tax registration number on your check.
,
,
.
26. Subtotal
(subtract line 25
from line 24)
4
Signature
,
,
.
27. * Add Penalty,
if Applicable
4
Print Name
(Minimum $5.00)
%
(
)
/
/
4
Phone Number
Date
,
,
.
Total Amount Due
28.
Internet/Fax
(10-22-10)
Page
1
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