Combined Excise Tax Return Form - Jan - Feb - Mar 2002
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5MAIL TO: State of Washington
Department of Revenue
JAN - FEB - MAR 2002
PO Box 34054
Q1
Seattle, WA 98124-1054
COMBINED EXCISE TAX RETURN
02
ONLY Fill in Box if Amended Return Information Attached
c
NAME
REG NO.
FIRM NAME
STREET ADDRESS
CITY, STATE, ZIP
Address Changes?
Business closed?
c
business location
c
mailing address
c
both
c
Date closed ____/____/____ See note section, pg 2.
I STATE BUSINESS AND OCCUPATION TAX
Please fill in the appropriate box and make address changes to the above label.
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
Extracting, Extracting for Hire
16
.00484
Slaughter, Break Proc, Perish Meat-Whlse; Mfg Wheat
2
30
.00138
into Flour; Raw Seafood; Soybean & Canola Proc
Travel Agent Com; Intl Charter Freight Brokers;
3
28
.00275
Stevedoring
4
Insurance Agents; Insurance Brokers Commis
14
.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
Royalties; Child Care
80
.00484
9
03
.00484
Wholesaling
Warehousing; Radio & TV Broadcasting; Public Road
10
11
.00484
Construction; Government Contracting
Public or Nonprofit Hospitals
.015
11
55
Cleanup of Radioactive Waste for US Gov’t;
12
83
.00471
Environmental Remedial Action
13
04
.015
Service & Other Activities
14
Retailing of Interstate Transportation Equip
19
.00484
15
Retailing
02
.00471
* Deductions taken but not itemized on pages 3 and 4 will be disallowed.
TOTAL B&O TAX
GROSS AMOUNTS FOR RETAILING AND
II STATE SALES AND USE TAX
RETAIL SALES MUST BE THE SAME
Retail Sales (also complete local tax section III)
.065
16
01
Value of articles used by taxpayer as a consumer
17
Use Tax (also complete local tax section III)
05
.065
on which no Washington sales tax has been paid
III LOCAL CITY AND/OR COUNTY SALES AND USE TAX
TOTAL STATE SALES & USE TAX
Local Sales Tax (Enter applicable rate of tax)
Code 45
APRIL 2002
DUE DATE: APRIL 30, 2002
30
Total Taxable Amount must be the same as line 16, column 3, Taxable Amount
S
M
T
W
T
F
S
«
5% Penalty Assessed After April 30, 2002
Line
1
2
3
4
5
6
No. Location Code
Taxable Amount
Local Rate
Tax Due City or Co.
10% Penalty Assessed After May 31, 2002
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8
9
10
11
12
13
20% Penalty Assessed After July 1, 2002
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14
15
16
17
18
19
20
If the due date falls on a weekend or legal holiday,
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22
23
24
25
26
27
19
the due date is extended to the next business day.
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29
30
20
o
4 4
Please fill in this box if you had no business activity.
(see note section, page 2)
4 4
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This return must be mailed, unless filed electronically.
4 4
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Please make check or money order payable to the Washington
State Department of Revenue. Do not send cash or coins.
TOTAL
TOTAL
TAXABLE
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For assistance, call (800) 647-7706.
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Local Use Tax (Enter applicable rate of tax)
Code 46
Signature
Total Value of Articles must be the same as line 17, column 1, Gross Amount
4 4
Ph. (
)
Date
Line
No. Location Code
Value of Articles
Local Rate Tax Due City or Co.
Line
Item
VIII TOTALS
No.
23
29
Total All Tax Due from page 1
24
30
Total All Tax Due from page 2
25
TOTAL VALUE
31
Rental Car Tax (attach Rental Car Tax Addendum)
OF ARTICLES
TOTAL
32
Subtotal (add lines 29-31)
Line
Tax
Code
Taxable Amount
Rate
Tax Due
No.
Classification
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Credit (from page 2, section VII, total credit)
Region Transit
34
Subtotal (subtract line 33 from line 32)
26
.004
89
Authority (RTA)
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Minimum
Add Penalty, if applicable
35
$5.00
King County
27
90
.005
Food & Bev
36
Interest
ò ò
TOTAL AMOUNT OWED
(add lines 34 - 36)
28
Litter Tax
36
.00015
c
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If you qualify, attach penalty waiver request and fill in box
(see note section, page 2)
REV 40 2406 Q1/02 (2-06-02)
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