Multi-Purpose Combined Excise Tax Return Form - 2002 Page 2
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5IV LODGING TAXES
TRANSIENT RENTAL INCOME INFORMATION
(enter location code and income only)
Code 47
Line
Location Code
Income
Location Code
Income
Location Code
Income
No.
37
38
CONVENTION AND TRADE CENTER TAX
Code 48
SPECIAL HOTEL/MOTEL TAX
Code 70
Line
Line
Location Code
Taxable Amount
Rate
Tax Due
Location Code
Taxable Amount
Rate
Tax Due
No.
No.
39
42
40
43
41
44
TOTAL CONVENTION & TRADE CENTER TAX
TOTAL SPECIAL HOTEL/MOTEL TAX
V STATE PUBLIC UTILITY TAX
Line
Column I
Col. 2 Deductions*
Column 3**
Col. 4
Column 5
Tax Classification
Code
No.
Gross Amount
Totals from Pg. 4
Taxable Amount
Rate
Tax Due
45
Water Distribution
60
.05029
46
Sewer Collection
61
.03852
47
Power
49
.03873
48
Gas Distribution; Telegraph
26
.03852
Motor Transportation; Railroad; Railroad Car
.01926
49
08
50
Urban Transportation; Vessels Under 65 ft
12
.00642
51
Other Public Service Business
13
.01926
** If taxable amounts on lines 45-51 column 3 total less than $2,000 monthly, $6,000 quarterly,
TOTAL STATE PUBLIC UTILITY TAX
i
i i
i
or $24,000 for annual filers, no Public Utility Tax is due.
VI OTHER TAXES
Line
Column I
Col. 2 Deductions*
Column 3
Col. 4
Column 5
Tax Classification
Code
No.
Gross Amount
Totals from Pg. 4
Taxable Amount
Rate
Tax Due
52
20
Tobacco Products
1.2942
53
64
Refuse Collection
.036
54
57
Temporarily Not Due - Fund Limit Reached
Petroleum Tax
.005
55
65
Hazardous Substance
.007
Intermediate Care Facilities for the
56
79
.06
Mentally Retarded (IMR)
* Deductions taken but not itemized on page 4 will be disallowed.
Line
Tax Classification
Code
Item
Quantity Sold
Rate
Tax Due
No.
Number of Stoves, Fireplaces, & Solid
$30.00
57
Solid Fuel Burning Device Fee
59
Fuel Burning Devices:
Number of Gallons
$1.00
58
54
Syrup Tax
(whole numbers only):
.20
59
93
State Enhanced 911 Tax
Number of Taxable Switched Access Lines:
TOTAL OTHER TAXES
PLEASE NOTE:
(Add lines 52-59)
If you do not have deductions, do not return pages 3 and 4.
If you have deductions, complete and return pages 3 and 4.
VII CREDITS
NEED HELP?
Line
Credit
Credit Classification
Amount
No.
I.D.
Internet Assistance – Go to DOR’s home page at
•
Click on FORMS to access forms including the Local City and/or
60
800
Multiple Activities Tax Credit (attach Schedule C)
County Sales and Use Tax Supplement, and other tax-related forms.
High Technology Credit
•
Under Tax Topics, click on BUSINESS for answers to frequently
61
830
(attach Research & Development Credit Affidavit)
asked questions and business closure information, and the
Manufacturing Software; Programming Rural Employment
Filing Your Tax Return link provides penalty waiver information.
62
860
B&O Credit
Under PUBLICATIONS, the Business Tax Guide link provides
tax return information and instructions.
63
865
Help Desk Services B&O Credit
•
To update your account information or to close your account with
64
Alternatives to Field Burning B&O Credit
875
the Department of Revenue, click on DOR SERVICES, then
Business Information Update.
65
855
International Services Credit
Telephone Assistance
Small Business B&O Tax Credit (see table on our website at
•
66
815
Call the Department of Revenue office nearest you or (800) 647-7706.
or call (800) 647-7706)
•
To file a No Business Activity return by telephone, call (800) 647-7706.
Electric Utility Rural Economic Development Revolving Fund
67
870
Enter code 111 and follow these steps: 1) Enter your 9-digit
Public Utility Tax Credit
registration number; 2) Verify the number entered; 3) Enter 3;
68
801
4) Respond to pre-recorded questions to file your return over the
Bad Debt Tax Credit (attach Schedule B)
telephone. Do not mail paper return back to the department.
69
805
Hazardous Substance
•
For penalty waiver criteria information, call (800) 334-8969 and
enter code 429.
Public Utility Tax Credit for Billing Discounts/Qualified Contributions
70
880
•
For business closure information, call (800) 334-8969 and
to a Low Income Home Energy Assistance Fund
enter code 430.
71
810
Other Credits (attach appropriate documents)
To inquire about the availability of this document in an alternate
format for the visually impaired, please call (360) 486-2342.
TOTAL CREDIT (transfer to page 1, line 33)
Teletype (TTY) users may call (800) 451-7985.
(6-17-02)
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