City Of Lacet Quarterly Tax Report Form, Annual Tax Report Page 2

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YEAR
LACEY TAX
DUE
TAX REPORT
NUMBER
DATE
ANNUAL
Small Business Startup B&O Tax Exemption: New small businesses within Lacey city limits after 1 Jan
420 COLLEGE ST SE
2015 and with gross income less than $500,000/year, qualify for a three (3) year exemption from Lacey
LACEY, WA 98503-1238 (360) 491-3212
B&O taxes. The form must still be filed, but no tax will be due. Please check here if you qualify (
).
CHECK HERE IF NO INCOME TO REPORT.
FILE BY DUE DATE TO AVOID
SUSPENSION/REVOCATION OF LICENSE AND
OTHER PENALTIES.
Name:
Address:
Address:
City/State/ZIP:
AS THE OWNER/MANAGER OR AUTHORIZED
AGENT FOR THIS BUSINESS, I DECLARE THIS
TAX REPORT TO BE CORRECT.
BUSINESS AND OCCUPATION TAX
DATED THIS_______DAY OF __________, 20____
GROSS
NET
TAX
DEDUCTIONS
TAX DUE
RECEIPTS
RECEIPTS
RATE
FIRM NAME_______________________________
Retailing
.001
Contractors
.001
PRINT NAME______________________________
Services
.002
PHONE___________________________________
Printing
.001
TOTAL
SIGNATURE______________________________
GROSS RECEIPTS: Do not include income from wholesale,
manufacturing for wholesale, gambling income, or income from
activities not conducted in the City of Lacey.
IF BUSINESS HAS BEEN SOLD OR
TOTAL
If total NET RECEIPTS is below $20,000 per year, no tax is due,
DISCONTINUED DURING THIS PERIOD,
DUE
however, the tax report MUST STILL BE FILED.
PLEASE COMPLETE THE FOLLOWING.
SOLD
DISCONTINUED
IN LACEY
DETAIL OF TAX DEDUCTIONS
Bad Debts
MAKE CHECK PAYABLE
DATE_________________________________
Cash Trade Discounts
TO THE CITY OF LACEY
Vehicle Fuel Sales
RETURN THIS PORTION WITH
NEW OWNER__________________________
Liquor Sales
YOUR PAYMENT
Total Tax Deductions
DMS: BORNWA
YEAR
LACEY TAX #.
KEEP THIS PORTION FOR YOUR RECORDS
BUSINESS AND OCCUPATION TAX
GROSS
NET
TAX
DEDUCTIONS
TAX DUE
RECEIPTS
RECEIPTS
RATE
Retailing
.001
Contractors
.001
Services
.002
Printing
.001
DATE___________________
CHECK #________________
Amount Paid to City of Lacey

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