Tax Report Quarterly - City Of Lacey
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1
2YEAR
LACEY TAX
DUE
TAX REPORT
NUMBER
DATE
QUARTERLY
420 COLLEGE ST SE
LACEY, WA 98503-1238 (360) 491-3212
BUSINESS NAME_____________________________________________________
CHECK HERE IF NO INCOME TO REPORT.
FILE BY DUE DATE TO AVOID
MAILING ADDRESS FOR TAX PURPOSES
SUSPENSION/REVOCATION OF LICENSE AND
OTHER PENALTIES.
STREET______________________________________________BOX___________
CITY_______________________________STATE_______ZIP_________________
BUSINESS AND OCCUPATION TAX
GROSS
NET
TAX
DEDUCTIONS
TAX DUE
RECEIPTS
RECEIPTS
RATE
Retailing
.001
IF BUSINESS HAS BEEN SOLD OR
DISCONTINUED IN LACEY DURING THIS
Contractors
.001
PERIOD, PLEASE COMPLETE THE
FOLLOWING.
Services
.002
Printing
.001
SOLD
DISCONTINUED
TOTAL
DATE_________________________________
GROSS RECEIPTS: Do not include income from wholesale,
manufacturing for wholesale, gambling income, or income from
NEW OWNER__________________________
activities not conducted in the City of Lacey.
TOTAL
AS THE OWNER/MANAGER OR
If total NET RECEIPTS is below $5,000 per year, no tax is due,
DUE
AUTHORIZED AGENT FOR THIS BUSINESS,
however, the tax report MUST STILL BE FILED.
I DECLARE THIS TAX REPORT TO BE
CORRECT.
DETAIL OF TAX DEDUCTIONS
DATED THIS _____ DAY OF __________, 20___
Bad Debts
FIRM NAME_____________________________
MAKE CHECK PAYABLE
Cash Trade Discounts
TO THE CITY OF LACEY
PRINT NAME____________________________
Vehicle Fuel – Tax Only
RETURN THIS PORTION WITH
Liquor Sales
SIGNATURE_____________________________
YOUR PAYMENT
Total Tax Deductions
YEAR
LACEY TAX #.
KEEP THIS PORTION FOR YOUR RECORDS
PERIOD
LICENS
BUSINESS AND OCCUPATION TAX
GROSS
NET
TAX
DEDUCTIONS
TAX DUE
RECEIPTS
RECEIPTS
RATE
Retailing
.001
Contractors
.001
Services
.002
Printing
.001
DATE___________________
Penalties
CHECK #________________
Amount Paid to City of Lacey
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