Multi-Purpose Combined Excise Tax Return - Washington Department Of Revenue
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4Washington State
Multi-Purpose
Department of Revenue
PO Box 34051
Seattle WA 98124-1052
Combined Excise Tax Return
MAIL TO:
Period
Year
/
Filing an Amended Return? Check this box and attach a letter of explanation.
Tax Registration Number
Use Black Ink &
Return Original Form
NAME
FIRM NAME
This Return is Effective
STREET ADDRESS
May 1, 2010 Forward
CITY, STATE, ZIP
Address Changes?
Business location
Mailing address
Business closed?
Date closed ___/___/___ See Help section, pg 2.
Other Correspondence?
Please fill in the appropriate box and note address changes above.
Use Black Ink & Return The Original Form
I STATE BUSINESS AND OCCUPATION TAX
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
16
Extracting, Extracting for Hire
.00484
Slaughter, Break Proc, Perish Meat-Whlse; Mfg Wheat
2
30
.00138
into Flour; Soybean & Canola Proc
Travel Agent Com/Tour Operators; Intl Charter Freight
3
28
.00275
Brokers; Stevedoring; Licensed Boarding Homes
Insurance Producers; Title Insurance Agents;
4
14
.00484
Surplus Line Broker Commissions
Prescription Drug Warehousing; Mfg: Bio/Alcohol Fuel,
5
21
.00138
or Split/Proc Dried Peas
6
10
Processing for Hire; Printing and Publishing
.00484
7
Manufacturing
07
.00484
8
Royalties; Child Care
80
.00484
9
03
Wholesaling
.00484
Warehousing; Radio & TV Broadcasting; Public Rd Const; Gov
10
11
.00484
Contracting; Chem Dependency Ctr; Canned Salmon Labelers
11
55
.015
Public or Nonprofit Hospitals; Qualified Food Co-ops
12
83
Cleanup of Radioactive Waste for US Gov
.00471
Service & Other Activities and/or Gambling
13
04
.018
Contests of Chance (less than $50,000 a year)
14
192
.0193
Gambling Contests of Chance ($50,000 a year or greater)
15
135
For Profit Hospitals; Scientific R&D
.015
16
19
Retailing of Interstate Transportation Equip
.00484
17
02
Retailing
.00471
* Deductions taken but not itemized on pages 3 and 4 will be disallowed.
TOTAL B&O TAX
GROSS AMOUNTS FOR RETAILING AND
RETAIL SALES MUST BE THE SAME
II STATE SALES AND USE TAX
18
Retail Sales (also complete local tax section III)
01
.065
Use Tax/Deferred Sales Tax (also complete local tax
Value of articles used by taxpayer as a consumer
19
05
.065
on which no Washington sales tax has been paid
section III)
TOTAL STATE SALES & USE TAX
III LOCAL CITY AND/OR COUNTY SALES AND USE TAX
If you have no business activity, check the box and
Local Sales Tax (Enter applicable rate of tax.)
Code 45
mail this return (unless filed electronically)
Total Taxable Amount must be the same as line 18, column 3, Taxable Amount
4
Please make check or money order payable to the Washington State Department of
Line
Location Code
Taxable Amount
Local Rate
Tax Due City or Co.
Revenue. Include your tax registration number on your check.
No.
4
20
Signature
21
4
Print Name
22
4
Ph. (
)
Date
23
5% Penalty Assessed After Due Date
15% Penalty Assessed After the Last Day of the Month Following the Due Date
TOTAL
TOTAL
TAXABLE
25% Penalty Assessed After Last Day of the Second Month Following the Due Date
If the due date falls on a weekend or legal holiday, the due date is extended
Local Use Tax/Deferred Sales Tax (Enter applicable rate of tax.) Code 46
to the next business day.
Total Value of Articles must be the same as line 19, column 1, Gross Amount
Line
Line
Location Code
Value of Articles
Local Rate Tax Due City or Co.
Item
VII TOTALS
No.
No.
24
29
Total All Tax Due from page 1
25
30
Total All Tax Due from page 2
TOTAL VALUE
TOTAL
31
Total All Addendums (example: Rental Car Addendum)
OF ARTICLES
32
Subtotal (add lines 29-31)
Tax
Line
Code
Taxable Amount
Rate
Tax Due
No.
Classification
33
Credit (from page 2, section VI, total credit)
Motor Vehicle
26
120
.003
Sales/Leases
34
Subtotal (subtract line 33 from line 32)
King County
27
90
35
.005
Add Penalty, if applicable
Minimum $5.00
Food & Bev
28
Litter Tax
36
TOTAL AMOUNT OWED (add lines 34 - 35)
.00015
Internet/Fax
Penalty waiver request? Attach and fill in box.
(see Help section, pg 2)
(6-18-10)
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