Form Rev 82 2090-1 - Tax Declaration For Cigarettes And Merchandise - 1998

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State of Washington
T
D
F
C
A
M
AX
ECLARATION
OR
IGARETTES
ND
ERCHANDISE
Department of Revenue
PO Box 47464
Purchased In A Taxing Jurisdiction Other Than Washington
Olympia, WA 98504-7464
Thank you for declaring your untaxed purchases. Under state law, residents are required to pay Washington taxes on cigarettes and
other tangible personal property purchased in other taxing jurisdictions. When you buy from a retailer in Washington, the taxes are
automatically added on, but when purchases are made in other taxing jurisdictions, residents need to declare and pay the taxes.
Unless the taxes are paid, the potential tax loss could affect funding for public education, fire districts, cities and counties. Your
cooperation in completing this form is sincerely appreciated. If you have questions, please contact the Department of Revenue
district office located nearest you (see following page).
Last Name (Please Print)
First
Middle Initial
Street Address (Include Apartment Number)
(
)
City
State
Zip Code
Telephone Number
CIGARETTE PURCHASES
Value
$
Cigarette Tax: Number of packages of 20’s
x $.825
1.
+
Cigarette Tax: Number of packages of 25’s
x $1.03125
2.
Purchase price paid for 20’s .............................................................................................
+
3.
Purchase price paid for 25’s .............................................................................................
+
4.
TOTAL (add lines 1, 2, 3, and 4) .....................................................................................
=
5.
Less Tax(es) paid in another jurisdiction on the cigarettes................................................
–
6.
=
TOTAL VALUE..............................................................................................................
7.
(To obtain the correct rate, please call the Department of Revenue district
x
Use Tax Rate
8.
office located nearest you. See following page)................................................
Use Tax Owed (multiply line 7 by 8)................................................................................
=
9.
=
TOTAL TAX OWED - Cigarette Purchases (add lines 1, 2, 9, subtract line 6) .............
10.
MERCHANDISE PURCHASES
Articles Purchased
Date of Purchase
Value
For Department Use Only
11.
/
/
$
Fund No.
Amount
12.
/
/
+
Use Tax
13.
/
/
+
# 001 - 0199
Water
=
TOTAL (add lines 11, 12, & 13) ........................................
14.
# 139 - 0125
–
Less sales tax(es) paid in another jurisdiction .....................
15.
Drug Education
# 181 - 0125
=
TOTAL VALUE ................................................................
16.
Health Care
(To obtain the correct rate, please call the
# 760 - 0125
Use Tax Rate
x
17.
district office nearest you. See following page)
General
(multiply line 16 by 17,
# 001 - 0125
=
USE TAX OWED - Merchandise
18.
subtract line 15) .........
TOTAL
=
TOTAL ENCLOSED (add lines 10 and 18)......................
19.
Please mail this completed
Department of Revenue
Signature
form along with your check to:
PO Box 47464
Date
Olympia, Wa 98504-7464
REV 82 2090-1 (3-16-98)
Make A Copy For Your Records

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