Multi-Purpose Combined Excise Tax Return Form - 2002
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5MAIL TO: State of Washington
Department of Revenue
MULTI-PURPOSE
PO Box 34051
Period
Seattle, WA 98124-1051
COMBINED EXCISE TAX RETURN
Year
ONLY Fill in Box if Amended Return Information Attached
REG NO
NAME
REG NO.
FIRM NAME
STREET ADDRESS
CITY, STATE, ZIP
Address Changes?
business location
mailing address
both
Business closed?
Date closed ___/___/___ See note section, pg 2.
Please fill in the appropriate box and note address changes above.
I STATE BUSINESS AND OCCUPATION TAX
Line
Column I
Col. 2 Deductions*
Column 3
Col. 4
Column 5
Tax Classification
Code
No.
Gross Amount
Totals from Pg. 3 & 4
Taxable Amount
Rate
Tax Due
1
16
Extracting, Extracting for Hire
.00484
Slaughter, Break Proc, Perish Meat-Whlse; Mfg Wheat
2
30
.00138
into Flour; Raw Seafood; Soybean & Canola Proc
Travel Agent Com/Tour Operators; Intl Charter Freight
3
28
.00275
Brokers; Stevedoring
4
14
Insurance Agents; Insurance Brokers Commis
.00484
Manuf Fresh Fruit and Veg; Split or Proc Dried Peas;
5
21
.00138
Prescription Drug Warehousing; Mfg Dairy Products
6
Processing for Hire; Printing and Publishing
10
.00484
7
Manufacturing
07
.00484
8
80
Royalties; Child Care
.00484
9
03
Wholesaling
.00484
Warehousing; Radio & TV Broadcasting; Public Road
10
11
.00484
Construction; Government Contracting
11
Public or Nonprofit Hospitals
55
.015
Cleanup of Radioactive Waste for US Gov’t;
12
83
.00471
Environmental Remedial Action
13
04
Service & Other Activities
.015
14
19
Retailing of Interstate Transportation Equip
.00484
15
02
Retailing
.00471
* Deductions taken but not itemized on pages 3 and 4 will be disallowed.
TOTAL B&O TAX
GROSS AMOUNTS FOR RETAILING AND
RETAIL SALES MUST BE THE SAME
II STATE SALES AND USE TAX
16
01
Retail Sales (also complete local tax section III)
.065
Use Tax/Deferred Sales Tax (also complete
Value of articles used by taxpayer as a consumer
17
05
.065
local tax section III)
on which no Washington sales tax has been paid
TOTAL STATE SALES & USE TAX
III LOCAL CITY AND/OR COUNTY SALES AND USE TAX
Please fill in this box if you had no business activity.
(see note section, pg. 2)
Local Sales Tax (Enter applicable rate of tax)
Code 45
This return must be mailed, unless filed electronically.
Total Taxable Amount must be the same as line 16, column 3, Taxable Amount
Line
If filing Amended Return, compute penalty ONLY if original return was assessed a
Location Code
Taxable Amount
Local Rate
Tax Due City or Co.
No.
penalty.
18
Please make check or money order payable to the Washington State
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Department of Revenue. Do not send cash or coins.
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For assistance, call (800) 647-7706.
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Signature
22
Ph. (
)
Date
TOTAL
TOTAL
TAXABLE
5 % Penalty Assessed After Due Date
Local Use Tax/Deferred Sales Tax (Enter applicable rate of tax) Code 46
10% Penalty Assessed After the Last Day of the Month Following the Due Date
Total Value of Articles must be the same as line 17, column 1, Gross Amount
20% Penalty Assessed After the Last Day of the Second Month Following the Due Date
Line
Location Code
Value of Articles
Local Rate Tax Due City or Co.
No.
If the due date falls on a weekend or legal holiday,
the due date is extended to the next business day.
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24
Line
Item
VIII TOTALS
No.
25
29
Total All Tax Due from page 1
TOTAL VALUE
TOTAL
OF ARTICLES
30
Total All Tax Due from page 2
Tax
Line
Code
Taxable Amount
Rate
Tax Due
31
Rental Car Tax (attach Rental Car Tax Addendum)
No.
Classification
32
Subtotal (add lines 29-31)
Region Transit
26
89
.004
Authority (RTA)
33
Credit (from page 2, section VII, total credit)
King County
27
90
.005
Food & Bev
34
Subtotal (subtract line 33 from line 32)
28
Litter Tax
36
.00015
35
Add Penalty, if applicable
Minimum $5.00
36
Interest
TOTAL AMOUNT OWED (add lines 34 - 36)
Penalty waiver request? Attach and fill in box.
(see note section, pg 2)
(6-17-02)
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