Quarterly / Annual Tax Return - City Of Bremerton
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1CITY OF BREMERTON
Tax & License Division
239 4th Street
Bremerton WA 98337
Quarter:
(automatically fills)
TAX
360-473-5311
Total Paid:
(automatically fills)
$
Business Mailing Address:
Enter Business Name
Enter Mailing Address
Enter City State Zip
Please retain this top portion for your records and remit the bottom half with payment. Thank You.
CITY OF BREMERTON QUARTERLY / ANNUAL TAX RETURN
SUMMARY OF TAX DUE
1. Total B/O Tax
RETURN THIS PORTION WITH YOUR PAYMENT - MAKE CHECK PAYABLE TO CITY OF BREMERTON
1. BUSINESS AND OCCUPATION TAX
($5 MIN.REQUIRED QTRLY, $20 MIN. REQUIRED ANNUALY)
$
-
BUSINESS CLASSIFICATION
2. Total Amusement
GROSS AMOUNT
DEDUCTIONS*
NET AMOUNT
RATE
TAX DUE
$
-
$
-
$
-
RETAILING
0.00125
3. Total Admissions
$
-
$
-
$
-
WHOLESALING
0.0016
4. Total Gambling
$
-
$
-
$
-
SERVICE
0.002
5. Other Gambling
$
-
TOTAL TAX DUE
PAY MINIMUM TAX OF $5.00 PER QTR
PENALTY**
$
-
1. TOTAL B/O TAX
CALCULATES TO $20 ANNUALY
$65.00
2004 Business License Fee
* IDENTIFY DEDUCTIONS (Options on Reverse Side)
IF YOUR TAXES ARE LATE
SEE PENALTY BOX BELOW FOR FEE RATE
$
AMOUNT ENCLOSED
2. AMUSEMENT DEVICE TAX
4. GAMBLING TAX
PENALTIES FOR LATE FILING
TOTAL GROSS
RATE
TAX DUE
TOTAL GROSS
RATE
TAX DUE
$
-
0.02
0.04
$
-
GREATER OF:
PUNCHBOARDS/PULL TABS
0.2
$
-
DAYS
PENALTY
MINIMUM
CARD GAMES
$
-
$
-
PAST DUE
RATE
PENALTY
2. TOTAL AMUSEMENT TAX
4. TOTAL GAMBLING TAX
1 to 30
10%
$3.00
31 to 60
15%
$4.00
3. ADMISSIONS TAX
5. OTHER GAMBLING TAX
60 or more
20%
$5.00
TOTAL GROSS
RATE
TAX DUE
TOTAL GROSS
LESS PRIZES
NET
RATE
TAX DUE
0.04
$
-
$
-
0.05
$
-
THEATRE
BINGO
0.05
$
-
$
-
0.1
$
-
SYMPHONY
RAFFLES
IF BUSINESS HAS BEEN SOLD. MOVED OR
0.05
$
-
$
-
0.02
$
-
AMUSEMENT RIDES
AMUSEMENT GAMES
DISCONTINUED DURING THIS QUARTER, PLEASE
0.05
$
-
$
-
0.1
$
-
OTHER
OTHER
COMPLETE THE FOLLOWING:
$
-
$
-
SOLD
MOVED
DISCONTINUED
3. TOTAL ADMISSIONS TAX
5. OTHER TOTAL GAMBLING TAX
NEW OWNER
Thank You
For Your Prompt Payment
TAX
ADDRESS
CALENDAR QUARTER / YEAR
OFFICE USE ONLY
LICENSE #
Enter License #
DATE
PHONE
□
Address Change
The undersigned taxpayer hereby declares that he/she has read this tax return and certifies it to be correct:
BUSINESS NAME & PHYSICAL ADDRESS:
Enter Business Name
Print Name:
Enter Physical Address
Signature/Title:
Enter City State Zip
Date:
Phone:
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