Form 12 - Combined Excise Tax Return - 1999
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4State of Washington
12
Department of Revenue
DECEMBER 1999
PO Box 34051
Seattle, WA 98124-1051
99
COMBINED EXCISE TAX RETURN
NAME
REG NO.
FIRM NAME
STREET ADDRESS
CITY, STATE, ZIP
Please make any address changes above. Check if this change
If your business closed, indicate date:___/____/____
I STATE BUSINESS AND OCCUPATION TAX
is your
business location,
mailing address, or
both.
For additional information, see note 5 on 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
Extracting, Extracting for Hire
.00484
1
16
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
.00275
3
28
Stevedoring
4
Insurance Agents/Insurance Brokers Commis
14
.00484
Manufacturing Fresh Fruits and Vegetables; Splitting or
5
21
.00138
Proc Dried Peas
6
Processing for Hire/Printing and Publishing
10
.00484
Manufacturing
.00484
7
07
.00484
8
Royalties; Child Care
80
9
Wholesaling
03
.00484
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
Service & Other Activities
.015
13
04
14
Retailing of Interstate Transportation Equip
19
.00484
Retailing
.00471
15
02
TOTAL B&O TAX
* Deductions taken but not explained on pages 3 and 4 will be disallowed.
GROSS AMOUNTS FOR RETAILING AND
RETAIL SALES MUST BE THE SAME
II STATE SALES AND USE TAX
16
Retail Sales (also complete local tax section)
01
.065
Value of articles used by taxpayer as a consumer
17
Use Tax (also complete local tax section)
05
.065
on which no Washington sales tax has been paid
TOTAL STATE SALES & USE TAX
4 4
LOCAL CITY AND/OR COUNTY SALES AND USE TAX
ü
Please check (
) this box if you had no business activity.
4 4
Local Sales Tax (Enter applicable rate of tax)
Code 45
This return must be filed even if no tax is due.
4 4
Total Taxable Amount must be the same as line 16, column 3, Taxable Amount
Please make check or money order payable to the Washington State
Department of Revenue. Do not send cash or coins.
Line
No. Location Code
Taxable Amount
Rate
Tax Due City or Co.
4 4
For assistance, call (800) 647-7706.
18
4 4
Signature
19
4 4
Ph. (
)
Date
20
5% Penalty is Due After January 25, 2000
21
DUE DATE
10% Penalty is Due After February 29, 2000
22
JANUARY 25, 2000*
20% Penalty is Due After March 31, 2000
TOTAL
LOCAL SALES TAX
*
If the due date falls on a weekend or legal holiday, the due date for the return
is extended to the next business day
.
Local Use Tax (Enter applicable rate of tax)
Code 46
Total Taxable Amount must be the same as line 17, column 1, Gross Amount
Line
Item
VII TOTALS
No.
Line
No. Location Code
Taxable Amount
Rate
Tax Due City or Co.
Total All Tax Due from page 1
29
23
30
Total All Tax Due from page 2
24
31
Rental Car Tax (attach Rental Car Tax Addendum)
25
Subtotal (add lines 29-31)
32
TOTAL
LOCAL USE TAX
33
Credit (from page 2, section VI, total credit)
Subtotal (subtract line 33 from line 32)
Line
34
Tax
Code
Taxable Amount
Rate
Tax Due
No.
Classification
«
Minimum
Penalty
35
$5.00
Region Transit
89
26
.004
Authority (RTA)
36
Interest
King County
27
90
.005
TOTAL AMOUNT OWED (ADD LINES 34 - 36)
Food & Bev
¨
«
If you qualify, attach penalty waiver request and check (ü) this box.
Litter Tax
.00015
28
36
(See note number 4 on page 2)
REV 40 2406 DEC99 (9-30-99)
Page 1
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