Combined Excise Tax Return Form - Jan - Feb - Mar 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
SPECIAL HOTEL/MOTEL TAX
Code 48
Code 70
Line
Line
Taxable Amount
Rate
Tax Due
No.
Location Code
Taxable Amount
Rate
Tax Due
Location Code
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
49
Motor Transportation; Railroad; Railroad Car
08
.01926
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 $6,000, no Public Utility Tax is due.
TOTAL STATE PUBLIC UTILITY TAX
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
Tobacco Products
20
1.2942
53
Refuse Collection
64
.036
Temporarily Not Due - Fund Limit Reached
54
Petroleum Tax
57
.005
55
Hazardous Substance
65
.007
Intermediate Care Facilities for the Mentally
56
79
.06
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 Fuel
57
Solid Fuel Burning Device Fee
59
$30.00
Burning Devices:
Number of Gallons
Syrup Tax
$1.00
58
54
(whole numbers only):
59
State Enhanced 911 Tax
93
Number of Taxable Switched Access Lines:
.20
TOTAL OTHER TAXES
PLEASE NOTE:
(Add lines 52-59)
If you do not have deductions, do not return pages 3 and 4.
VII CREDITS
If you have deductions, complete and return pages 3 and 4.
NEED HELP?
Line
Credit
Internet Assistance – Go to DOR’s home page at
Credit Classification
Amount
I.D.
No.
•
Click on FORMS to access forms including the Local City and/or
60
Multiple Activities Tax Credit (attach Schedule C)
800
County Sales and Use Tax Supplement, and other tax-related
forms.
High Technology Credit
•
Under Tax Topics, click on BUSINESS for answers to
61
830
(attach Research & Development Credit Affidavit)
frequently asked questions and business closure
Manufacturing Software; Programming Rural Employment B&O
information. The Business Tax Guide link provides tax
62
860
return information and instructions, and the Filing Your Tax
Credit
Return link provides penalty waiver information.
63
865
Help Desk Services B&O Credit
•
To update your account information or to close your account
with the Department of Revenue, click on DOR SERVICES,
64
875
Alternatives to Field Burning B&O Credit
then Business Information Update.
Telephone Assistance
65
855
International Services Credit
•
Call the Department of Revenue office nearest you or (800) 647-
66
815
Small Business B&O Tax Credit (see table enclosed)
7706.
•
To file a No Business Activity return by telephone, call (800) 647-
Electric Utility Rural Economic Development Revolving Fund
67
870
7706. 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
Bad Debt Tax Credit (attach Schedule B)
the telephone. Do not mail paper return back to the
69
805
Hazardous Substance
department.
•
For penalty waiver criteria information, call (800) 334-8969
Public Utility Tax Credit for Billing Discounts/Qualified Contributions
and enter code 429.
70
880
to a Low Income Home Energy Assistance Fund
•
For business closure information, call (800) 334-8969
and enter code 430.
71
810
Other Credits (attach appropriate documents)
For tax assistance visit or call (800) 647-7706.
To inquire about the availability of this document in an alternate
TOTAL CREDIT (transfer to page 1, line 33)
format for the visually impaired, please call (360) 486-2342.
Teletype (TTY) users may call (800) 451-7985.
REV 40 2406 Q1/02 (2-06-02)
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