Combined Excise Tax Return - Washington Department Of Revenue - 2005
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4MAIL TO:
Washington State
March 2005
Department of Revenue
03
PO Box 34051
Seattle WA 98124-1051
Combined Excise Tax Return
05
ONLY Fill in Box if Amended Return Information Attached
NAME
TAX REG NO.
FIRM NAME
STREET ADDRESS
CITY, STATE, ZIP
Address Changes?
business location
mailing address
both
Business closed?
Date closed ___/___/___ See Help section, pg 2.
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; Raw Seafood; Soybean & Canola Proc
Travel Agent Com/Tour Operators; Intl Charter Freight
3
28
.00275
Brokers; Stevedoring; Licensed Boarding Homes
4
Insurance Agents; Insurance Brokers Commis
14
.00484
Prescription Drug Warehousing; Mfg: Fresh Fruit & Veg,
5
21
.00138
Dairy Products, Bio/Alcohol Fuel, or Split/Proc Dried Peas
6
10
Processing for Hire; Printing and Publishing
.00484
7
07
Manufacturing
.00484
8
Royalties; Child Care
80
.00484
9
03
Wholesaling
.00484
Warehousing; Radio & TV Broadcasting; Public Rd Const;
10
11
.00484
Gov Contracting; Chem Dependency Ctr
11
55
Public or Nonprofit Hospitals
.015
Cleanup of Radioactive Waste for US Gov
12
83
.00471
13
04
Service & Other Activities
.015
14
19
Retailing of Interstate Transportation Equip
.00484
15
Retailing
02
.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
16
Retail Sales (also complete local tax section III)
01
.065
Use Tax/Deferred Sales Tax (also complete
Value of articles used by taxpayer as a consumer
17
05
.065
local tax section III)
on which no Washington sales tax has been paid
TOTAL STATE SALES & USE TAX
III LOCAL CITY AND/OR COUNTY SALES AND USE TAX
Local Sales Tax (Enter applicable rate of tax.)
Code 45
If you have no business activity, check the box and
Total Taxable Amount must be the same as line 16, column 3, Taxable Amount
mail this return (unless filed electronically)
Line
Location Code
Taxable Amount
Local Rate
Tax Due City or Co.
No.
DUE DATE: April 20, 2005
18
5% Penalty Assessed After April 20, 2005
19
15% Penalty Assessed After May 31, 2005
25% Penalty Assessed After June 30, 2005
20
If the due date falls on a weekend or legal holiday, the
21
due date is extended to the next business day.
22
4
Please make check or money order payable to the Washington State Department of
TOTAL
TOTAL
Revenue. Include your tax registration number on your check. Do not mail cash or coins.
TAXABLE
4
For assistance, call 1-800-647-7706.
Local Use Tax/Deferred Sales Tax (Enter applicable rate of tax.) Code 46
4
Total Value of Articles must be the same as line 17, column 1, Gross Amount
Signature
Line
4
Location Code
Value of Articles
Local Rate Tax Due City or Co.
Ph. (
)
Date
No.
Line
23
Item
VIII TOTALS
No.
24
29
Total All Tax Due from page 1
TOTAL VALUE
TOTAL
OF ARTICLES
30
Total All Tax Due from page 2
Line
Tax
Code
Taxable Amount
Rate
Tax Due
31
Total All Addendums (example: Rental Car Addendum)
No.
Classification
Motor Vehicle
32
Subtotal (add lines 29-31)
25
120
.003
Sales/Leases
33
Credit (from page 2, section VII, total credit)
Region Transit
26
89
.004
Authority (RTA)
34
Subtotal (subtract line 33 from line 32)
King County
27
90
.005
Food & Bev
35
Add Penalty, if applicable
Minimum $5.00
Litter Tax
28
36
.00015
TOTAL AMOUNT OWED (add lines 34 - 35)
Internet/Fax
Penalty waiver request? Attach and fill in box.
(see Help section, pg 2)
(1-18-05)
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