Natural Gas Use Tax Return Form - Washington State - 2009
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4APR - MAY - JUN 2009
Washington State
Department of Revenue
PO Box 47464
NATURAL GAS USE TAX RETURN
Q2
09
Olympia WA 98504-7464
Tax Registration Number
Use Black Ink &
Name
Return Original Form.
Business Name
Street Address
City, State, Zip
Address Changes?
Date closed
Business Location
Mailing Address
Both
Business Closed?
.
VOLUME
Total Value
Purchase Price
Transportation Charges
(in therms)
,
+
.
,
,
,
,
,
.
,
.
=
1.
Total State Tax Due
,
,
.
03852)
(Total Value from line 1, multiplied by Tax Rate .
II. LOCAL CITY NATURAL GAS USE TAX
Total City Value
Loc. City Code
Local Rate
City Tax Due
x
,
.
,
.
.
,
=
2.
.
x
,
,
.
,
.
.
=
3.
,
,
x
.
.
,
.
=
4.
,
,
,
.
.
.
x
=
5.
,
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,
,
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x
=
6.
,
,
.
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x
=
7.
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,
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x
=
8.
Total City Value
Total City Tax Due
,
,
.
,
,
.
(add lines 2-8)
(add lines 2-8)
. .
III. STATE CREDITS
Consumer Paid Use Tax
Seller Paid State Gross Receipts
Total State Credit
(Credit for Tax Paid
,
,
,
,
.
.
.
9.
In Another State)
IV. LOCAL CITY CREDITS
Consumer Paid Use Tax
Seller Paid Municipal Gross Receipts
Loc. City Code
Total Local Credit
.
,
,
,
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,
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10.
,
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11.
Total State/City Credits
,
.
,
DUE DATE: July 31, 2009
(add lines 9-11)
* 5% Penalty Assessed After July 31, 2009
V. Totals
15% Penalty Assessed After August 31, 2009
25% Penalty Assessed After September 30, 2009
,
,
.
Tax Due
12.
If the due date falls on a weekend or legal holiday,
the due date is extended to the next business day.
,
Less Credits
,
.
13.
Signature
,
Subtotal
,
.
14.
(
)
/
/
Phone Number
Date
*Add Penalty,
If Applicable
For tax assistance, visit dor.wa.gov or call (360) 902-7036. To inquire
15.
,
,
.
about the availability of the document in an alternate format for the
(Minimum $5.00)
%
visually impaired, please call (360) 705-6715. Teletype (TTY) users may
call 1-800-451-7985.
,
16. Total Amount Due
,
.
REV 41 0065
(5/27/09)
Page
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