Utility Occupation Tax Return Form - City Of Des Moines

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CITY OF DES MOINES
UTILITY OCCUPATION TAX RETURN
City of Des Moines
Finance Department
21630 11th Ave South
Business Name
Des Moines, WA 98198
Phone: (206)878-4595
Reporting
Due
Registration
Period
Date
Number
Tax Classification
Gross Receipts
Deductions
Taxable Receipts
Tax Rate
Tax Due
ELECTRICITY
6%
NATURAL GAS
6%
SOLID WASTE COLLECTION
6%
CABLE TV
6%
TELEPHONE
6%
CELLULAR
6%
Penalty:
10% of tax 16 days after due date
TAX
Interest:
12% per annum
PENALTY
I hereby certify that the statements and information provided on this
tax return are true and complete to the best of my knowledge.
INTEREST
________________________________________ (
)
TOTAL DUE
Signature
Telephone
________________________________________
Print Name
Date
_____________________________________________
Title
Office Use
Receipt to
Electricity
001.000.000.316.41.00.00
83.33%
Please indicate changes in business operations below:
Electricity
105.000.000.316.41.00.00
16.67%
Natural Gas
001.000.000.316.43.00.00
83.33%
Sold New Owner ___________________________________ Natural Gas
105.000.000.316.43.00.00
16.67%
Address ___________________________________ Solid Waste
001.000.000.316.45.00.00
83.33%
Solid Waste
105.000.000.316.45.00.00
16.67%
Change Address to: ___________________________________ Cable TV
001.000.000.316.46.00.00
83.33%
___________________________________ Cable TV
105.000.000.316.46.00.00
16.67%
Telephone
001.000.000.316.47.00.00
83.33%
Discontinued Business on: ___________________________________ Telephone
105.000.000.316.47.00.00
16.67%
Form Dated 2/00

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