Form Q3-10 - Business & Occupation Activities Return - 2010
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5July-August-September 2010
Mail to:
State of Washington
Q
3 10
Department of Revenue
Business & Occupation Activities Return
PO Box 34051
Seattle, WA 98124-1051
Tax Registration Number
Use Black Ink &
4
Name
Return Original Form.
Business Name
Street Address
City, State, Zip
Filing an Amended Return?
Has Your Address Changed?
Business Closed?
If so, check appropriate box(es) below and note changes on address above.
Check this box and attach amended return
Check this box and enter date closed.
information and a letter of explanation.
Business Location Change
Mailing Address Change
Other Correspondence?
I. State Business and Occupation (B&O) Tax
Travel Agent Comm/Tour Operator; Intl Charter Freight Brokers; Stevedoring; Licensed Boarding Homes [28]
Gross Amount
Deductions*
Taxable Amount
Rate
Tax Due
,
,
,
,
,
,
.
.
,
.
.
X
-
=
1.
.00275
Insurance Producers; Title Insurance Agents; Surplus Line Broker Commissions [14]
Gross Amount
Taxable Amount
Tax Due
Deductions*
Rate
,
,
,
,
,
,
.
.
,
.
.
X
-
=
2.
.00484
Royalties; Child Care [80]
Gross Amount
Taxable Amount
Tax Due
Deductions*
Rate
,
,
,
,
,
,
.
.
,
.
.
X
-
=
3.
.00484
Wholesaling [03]
Gross Amount
Deductions*
Taxable Amount
Rate
Tax Due
,
,
,
,
,
,
.
.
,
.
.
X
-
=
4.
.00484
For Profit Hospitals; Scientific R&D [135]
Gross Amount
Taxable Amount
Tax Due
Deductions*
Rate
,
,
,
,
,
,
.
.
,
.
.
X
-
=
5.
.015
Service & Other Activities [04]
Gross Amount
Taxable Amount
Tax Due
Deductions*
Rate
,
,
,
,
,
,
.
.
,
.
.
X
-
=
6.
.018
*
Deductions taken but not itemized on pages 3 & 4 will be disallowed.
State and Local Use Tax/Deferred Sales Tax (See page 2.)
4
DUE DATE: October 31, 2010
IV. Totals
* 5% Penalty Assessed After November 01, 2010
15% Penalty Assessed After November 30, 2010
,
,
.
20. Total Tax Due from Section I
25% Penalty Assessed After January 03, 2011
(Tax due from lines 1-6)
If the due date falls on a weekend or legal holiday,
the due date is extended to the next business day.
,
,
.
21. Total Tax Due from Section II
(Tax due from line 12)
No Business Activity?
File by telephone: Call 1-800-647-7706.
22. Total All Addendums
,
(Example:
,
.
At the greeting, enter code 111 to start the process. Enter your 9-digit
Local Sales/Use Tax)
tax registration number and follow the instructions given. If you file by
telephone, do not mail us your return; or
,
,
.
23. Subtotal
(add lines 20-22)
If you have no business activity and did not file by telephone, check this
box, sign and mail us your return.
,
,
.
24. Total Credit from Section III
4
Make check or money order payable to the Washington State Department
(from page 2, line 19)
of Revenue.
,
,
4
.
Please write your tax registration number on your check.
25. Subtotal
(subtract line 24
from line 23)
4
Signature
,
,
.
26. * Add Penalty,
if Applicable
4
Print Name
(Minimum $5.00)
%
(
)
/
/
4
Phone Number
Date
,
,
.
Total Amount Due
27.
Internet/Fax
(7-27-10)
Page
1
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