Utility Tax Return Form - City Of Shoreline

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Mail Tax Returns and
Correspondence to:
City of Shoreline
City of Shoreline Finance Dept.
UTILITY TAX RETURN
17544 Midvale Ave. N.
Shoreline WA 98133
(206) 546-8737
SECTION 1: Business Information
Utility Business Name: __________________________________________________
Contact Person: ________________________________________________________
Contact Address: ______________________________________________________________________
Contact Phone: (____)______________________ Fax: (____)____________________
Please note any changes in your business:
Business status (closed, sold, etc.) Please explain:_________________________________________
New Address: ______________________________________________________________________
New Phone (_____)____________________
New Business Name and/or DBA ______________________________________________________
SECTION 2: Gross Receipts Tax
Reporting Period:_______________
For Internal Use
Tax Classification
Gross
Deductions, if
Taxable
Tax
Tax Due
Only
Receipts
any
Receipts
Rate
(see below)
0010000-3164600
Cable
1%
0010000-3219100
Cable (Franchise Fee)
5%
0010000-3164702
Cellular phone
6%
0010000-3164701
Telephone
6%
0010000-3164703
Pager
6%
0010000-3164300
Natural Gas
6%
0010000-3164500
Solid Waste
6%
AMOUNT OF PAYMENT: $______________
(Make check payable to City of Shoreline)
Deductions: The following items may be deducted from the total gross income upon which the tax is computed:
A. Credit losses actually sustained by taxpayers whose regular books are kept on an accrual basis.
B. That portion of gross income derived from charges to another telecommunications company for connecting
fees, switching charges, or carrier access charges relating to intrastate toll telephone services, or for access to,
or charges for, interstate services, or charges for telephone service which the purchaser buys for the purpose
of resale.
C. Adjustments made to a billing or customer account in order to reverse a billing or charge that was not
properly a debt of the customer.
D. Amounts derived from a business which the City is prohibited from taxing under the constitution of this state
or the Constitution or laws of the United States.
Grants from governmental agencies.
E.
ATTACH ITEMIZATION OF YOUR DEDUCTIONS WITH THIS FORM.
I hereby certify that the information provided on this tax return is true to the best of my knowledge.
__________________________________ ____________________________
_________________
Name
Title
Date
G:\FIN\BUDGET\Utility Revenue Comprehensive\UtilityTaxReturn.doc

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