City Of Lake Forest Park Business And Occupation Tax Report
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1CITY OF LAKE FOREST PARK BUSINESS AND OCCUPATION TAX REPORT
ALL BUSINESSES MUST FILE A BUSINESS AND OCCUPATIONAL TAX REPORT
ACCOUNT NUMBER
PLEASE COMPLETE AND SUBMIT REPORT.
NO TAX IS DUE IF GROSS SALES TOTAL LESS THAN $5,000.00
NAME
Filing Period
Due
ADDRESS
1 QTR JAN, FEB, MAR
4/30
CITY, STATE, ZIP
2 QTR APR, MAY, JUN
7/31
3 QTR JUL, AUG, SEP
10/31
4 QTR OCT, NOV, DEC
1/31
COLUMN 1
C
OLUMN 2
COLUMN 3
COLUMN 4
CO
LUMN
5
COLUMN 6
BUSINESS
GROSS
DEDUCTIONS
TAXABLE
X RATE
TAX DUE
CLASSIFICATION
RECEIPT
AMOUNT
AMOUNT
1
.002
2
.002
3
.002
PENALTY:
LINE A – Total of Column 6
1 to 30 days late ……..add $5.00
LINE B ‐ Penalty
31 to 60 days late …...add $10.00
61 to 90 days late …....add $15.00
LINE C – Overpayment/Underpayment
LINE D – Total Tax and Penalty
Type of Deduction
Explanation
Amount
Examples of the m
ost common exemptions and d
eductions:
•
Liquor, beer, and wine sales
•
Manufacturing, selling, or distribution of motor ve
hicle fuel
•
Cash discounts taken by customers
•
Credit losses or bad debts sustained by customers
MAIL TAX RETURN TO: City of Lake Forest Park MAKE CHECKS PAYABLE TO: City of Lake Forest Park
17425 Ballinger Way NE
Lake Forest Park, WA 98155‐5556
STATEMENT BY TAXPAYER
I/we hereby certify under the penalties of perjury that the sum above shown in the amount of tax for which I/we are liable for
t
he period above shown under and computed according to the provisions of the Ordinance. I/we further certify that the
i
nformation herein given and the amount of the tax liability herein reported are full and true and I/we know the same to be so.
SIGNED
DATE
B
Y
TITLE
Complete this space if you are NO LONGER OPERATING or if there
has been a SALE OR TRANSFER
Date Discontinued___________________________________________________
Name of New Owner________________________________________________
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