Form 11 - Combined Excise Tax Return - 2000
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4State of Washington
11
Department of Revenue
NOVEMBER 2000
PO Box 34051
Seattle, WA 98124-1051
00
COMBINED EXCISE TAX RETURN
Fill in Box if Amended/Supplemental Return or Correspondence is Attached
NAME
REG NO.
FIRM NAME
STREET ADDRESS
CITY, STATE, ZIP
Make any address changes above. Fill in box if this change is
If your business closed, fill in the box
and
your
business location,
mailing address, or
both.
I STATE BUSINESS AND OCCUPATION TAX
indicate date:___/___/____. See note 5, page 2.
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 and
3
28
.00275
Stevedoring
4
Insurance Agents/Insurance Brokers Commis
14
.00484
5
Manuf Fresh Fruit and Veg; Split or Proc Dried Peas
21
.00138
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
11
Public or Nonprofit Hospitals
55
.015
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
16
Retail Sales (also complete local tax section III)
01
.065
Value of articles used by taxpayer as a consumer
17
Use Tax (also complete local tax section III)
.065
05
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
DECEMBER 2000
DUE DATE: DECEMBER 25, 2000
Total Taxable Amount must be the same as line 16, column 3, Taxable Amount
S
M
T
W
T
F
S
25
5% Penalty is Due After December 26, 2000
Line
1
2
No. Location Code
Taxable Amount
Rate
Tax Due City or Co.
10% Penalty is Due After January 31, 2001
3
4
5
6
7
8
9
20% Penalty is Due After February 28, 2001
18
10
11
12
13
14
15
16
If the due date falls on a weekend or legal holiday,
17
18
19
20
21
22
23
19
the due date is extended to the next business day.
24/31
25
26
27
28
29
30
20
Please fill in this box if you had no business activity.
(See note 6 page 2)
21
This return must be filed even if no tax is due.
22
Please make check or money order payable to the Washington
State Department of Revenue. Do not send cash or coins.
TOTAL
TAXABLE
TOTAL
For assistance, call (800) 647-7706.
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
Ph. (
)
Date
Line
No. Location Code
Value of Articles
Rate
Tax Due City or Co.
Line
Item
VIII TOTALS
No.
23
Total All Tax Due from page 1
29
24
Total All Tax Due from page 2
30
25
31
Rental Car Tax (attach Rental Car Tax Addendum)
TOTAL VALUE
TOTAL
OF ARTICLES
32
Subtotal (add lines 29-31)
Line
Tax
Code
Taxable Amount
Rate
Tax Due
33
Credit (from page 2, section VII, total credit)
No.
Classification
Region Transit
34
Subtotal (subtract line 33 from line 32)
26
89
.004
Authority (RTA)
Minimum
Penalty
35
$5.00
King County
27
90
.005
Food & Bev
36
Interest
28
Litter Tax
36
.00015
TOTAL AMOUNT OWED (ADD LINES 34 - 36)
REV 40 2406 NOV00 (8-28-00)
Page 1
If you qualify, attach penalty waiver request and fill in this box
(See note number 4 on page 2)
.
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