Multi-Purpose Combined Excise Tax Form - State Of Washington Department Of Revenue
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1
2
3
4State of Washington
Department of Revenue
Period
Year
PO Box 34052
Seattle, WA 98124-1052
MULTI-PURPOSE COMBINED EXCISE TAX
Regular Return
Amended Return
Supplemental Return
NAME
REG NO.
FIRM NAME
MAILING ADDRESS
CITY, STATE, ZIP
Please make any address changes above. Check if this change
I STATE BUSINESS AND OCCUPATION TAX
/
/
.
If your business closed, indicate date:
is a
business location,
mailing address, or
both.
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
Extracting, Extracting for Hire
.00484
1
16
Slaughter, Break Proc, Perish Meat-Whlse, Mfg Wheat
2
30
.00138
into Flour, Raw Seafood, Soybean & Canola Processing
3
Travel Agent Com/Splitting or Proc Dried Peas
28
.00275
Intl Charter Freight Brokers and Stevedoring
.00363
4
18
5
Insurance Agents/Insurance Brokers Commis
14
.0055
6
Manufacturing Fresh Fruits and Vegetables
21
.00330
7
Processing for Hire/Printing and Publishing
10
.00484
8
Manufacturing
07
.00484
Wholesaling Wheat, Oats, Corn, Barley, Dry Peas, Dry
.00011
9
15
Beans, Lentils, Triticale, Canola
10
Internal Dist - 2 or More Outlets - No Sales
06
.00484
11
Wholesaling
03
.00484
Warehousing, Radio & TV Broadcasting, Public Road
12
11
.00484
Construction/Government Contracting
13
Public or Nonprofit Hospitals
55
.015
Selected Business Services
.02
14
58
15
Financial Business Services
72
.016
Cleanup of Radioactive Waste for US Gov’t
.00471
16
83
17
Service & Other Activities
04
.0175
18
Retailing of Interstate Transportation Equip
19
.00484
Retailing
.00471
19
02
* DEDUCTIONS TAKEN BUT NOT EXPLAINED ON PAGES 3 AND 4 WILL BE DISALLOWED.
TOTAL B&O
GROSS AMOUNTS FOR RETAILING AND
II STATE SALES AND USE TAX
RETAIL SALES MUST BE THE SAME
20
Retail Sales (also complete local tax section)
01
.065
Value of articles used by taxpayer as a consumer
21
Use Tax (also complete local tax section)
05
.065
on which no Washington sales tax has been paid
LOCAL CITY AND/OR COUNTY SALES AND USE TAX
Please check (
) this box if you had no business activity.
LOCAL SALES TAX (Enter applicable rate of tax)
[45]
This return must be filed even if no tax is due.
Line
If filing Amended Return, compute penalty ONLY if original return was
No. Location Code
Taxable Amount
Rate
Tax Due City or Co.
assessed a penalty .
23
Please make check or money order payable to the Washington State
Department of Revenue. Do not send cash or coins.
24
Signature
25
Ph. (
)
Date
26
5% Penalty Assessed After Due Date
27
10% Penalty Assessed After the Last Day of the Month Following the Due Date
28
Total
[29]
20% Penalty Assessed After the Last Day of the Second Month Following the
Due Date
Line 28 Total Taxable Amount, must be the same as line 20, column 3, Taxable Amount
*
If the due date falls on a weekend or legal holiday, the due date for the
LOCAL USE TAX (Enter applicable rate of tax)
[46]
return is extended to the next business day
.
Line
Line
No. Location Code
Taxable Amount
Rate
Tax Due City or Co.
Item
VII TOTALS
No.
30
Total All Tax Due from page 1
35
31
Total Tax Due from page 2, line 69
36
32
37
Rental Car Tax (attach Rental Car Tax Addendum)
33
Total
[34]
38
Subtotal (add lines 35-37)
Line 33 Total Taxable Amount, must be the same as line 21, column 1, Gross Amount
Credit (from page 2, line 78)
39
Tax Classification Code
Taxable Amount
Rate
Tax Due
40
Subtotal (subtract line 39 from line 38)
Minimum
Penalty
(See note number 4 on page 2)
Regional Transit
41
89
.004
$5.00
Authority (RTA)
42
Interest
King Cnty Food/Bev
90
.005
43
Total Amount You Owe (add lines 40-42)
Please check (
) if you prefer a
Credit or
Refund.
REV 40 2406 MULTI-JUNE97 (06-30-97)
Page 1
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