Business And Occupation Tax Return Form - City Of Bellingham

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CITY OF BELLINGHAM
TAX
Finance Department • City Hall • 210 Lottie Street • Bellingham, WA 98225 • Phone (360) 778-8010
IS DUE:
• Fax (360) 778-8001
BUSINESS AND OCCUPATION TAX RETURN
TAX PERIOD:
BUSINESS REGISTRATION NO.
Business Name
Bus. Phone
Bus. Fax
Business Location
Start Date
Sic Code
Mailing Address
Rate Type
Business Type
Description of Business
Ownership
E-mail Address
WA State UBI No.
Federal I.D. No.
UPDATE BELOW NAMES OF OWNERS, PARTNERS, OR CORPORATE OFFICERS - Attach additional page if necessary
Owner Name
Title
Phone
Home Address
Cell Phone
Social Security No.
Driver’s License No.
Owner Name
Title
Phone
Home Address
Cell Phone
Social Security No.
Driver’s License No.
EMERGENCY CONTACT:
Name
Title
Phone
Address
Cell Phone
ALARM COMPANY: (if applicable)
Name
Title
Phone
Address
License No.
PLEASE CALCULATE TOTAL TAX DUE BY ENTERING AMOUNTS IN BOXES BELOW:
(Instructions on reverse side)
TAX DEDUCTIONS
TAXABLE
TAX
BUSINESS
GROSS
LIQUOR,
OTHER
TAX DUE
CASH
BAD
RATE
RECEIPTS
AMOUNT
CLASSIFICATION
GAMBLING &
INTERSTATE
DEBTS
DISCOUNTS
GASOLINE SALES
.0017
EXTRACTING
1 2 3 4 5 6 7 8 9 0 1 2 3 4
1 2 3 4 5 6 7 8 9 0 1 2 3 4
1 2 3 4 5 6 7 8 9 0 1 2 3 4
1 2 3 4 5 6 7 8 9 0 1 2 3 4
MANUFACTURING
.0017
1 2 3 4 5 6 7 8 9 0 1 2 3 4
1 2 3 4 5 6 7 8 9 0 1 2 3 4
RETAILING
.0017
WHOLESALING
.0017
1 2 3 4 5 6 7 8 9 0 1 2 3 4
1 2 3 4 5 6 7 8 9 0 1 2 3 4
1 2 3 4 5 6 7 8 9 0 1 2 3 4
SERVICE &
1 2 3 4 5 6 7 8 9 0 1 2 3 4
.0044
1 2 3 4 5 6 7 8 9 0 1 2 3 4
1 2 3 4 5 6 7 8 9 0 1 2 3 4
OTHER ACTIVITIES
1 2 3 4 5 6 7 8 9 0 1 2 3 4
1 2 3 4 5 6 7 8 9 0 1 2 3 4
TOTAL TAX DUE THIS PERIOD
❑
CHECK BOX IF MATC FORM ATTACHED
CREDIT AMOUNT $ ____________
PENALTIES
IF BUSINESS CLOSED - Date of Closure _________________________________
(SEE INSTRUCTIONS ON REVERSE SIDE)
PREVIOUS BALANCE
IF OWNERSHIP HAS CHANGED OR BUSINESS HAS CLOSED,
PLEASE COMPLETE INFORMATION ON REVERSE SIDE.
TOTAL DUE
I certify, under penalty of perjury, that I have examined this return and any accompanying schedules and statements, and to the best of my
knowledge and belief, it is a true, correct and complete return.
Signature of Owner or Representative:
Title:
Date:
RETURN COMPLETED TAX RETURN TO ABOVE ADDRESS AND MAKE CHECK PAYABLE TO CITY OF BELLINGHAM

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