Form Tax Report - Quarterly - 2015
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1
2QTR/YR
LACEY TAX
DUE
TAX REPORT
NUMBER
DATE
QUARTERLY
2015 Small Business Startup B&O Tax Exemption: New small businesses within Lacey (gross income
420 COLLEGE ST SE
less than $500,000/year) qualify for a three (3) year exemption from Lacey B&O taxes. The form must still
LACEY, WA 98503-1238 (360) 491-3212
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:
IF BUSINESS HAS BEEN SOLD OR
DISCONTINUED DURING THIS PERIOD,
PLEASE COMPLETE THE FOLLOWING.
BUSINESS AND OCCUPATION TAX
SOLD
DISCONTINUED
IN LACEY
GROSS
NET
TAX
DEDUCTIONS
TAX DUE
RECEIPTS
RECEIPTS
RATE
DATE_________________________________
Retailing
.001
Contractors
.001
NEW OWNER__________________________
Services
.002
Printing
.001
TOTAL
GROSS RECEIPTS: Do not include income from wholesale,
manufacturing for wholesale, gambling income, or income from
AS THE OWNER/MANAGER OR AUTHORIZED
AGENT FOR THIS BUSINESS, I DECLARE THIS
activities not conducted in the City of Lacey.
TAX REPORT TO BE CORRECT.
TOTAL
If total NET RECEIPTS is below $5,000 per qtr, no tax is due,
DUE
however, the tax report MUST STILL BE FILED.
DATED THIS______ DAY OF __________, 20____
DETAIL OF TAX DEDUCTIONS
FIRM NAME_______________________________
Bad Debts
PRINTED NAME____________________________
MAKE CHECK PAYABLE
Cash Trade Discounts
TO THE CITY OF LACEY
Vehicle Fuel Sales
PHONE___________________________________
RETURN THIS PORTION WITH
Liquor Sales
YOUR PAYMENT
SIGNATURE_______________________________
Total Tax Deductions
QTR/YR
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
DMS: BORNWQ.DOC
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