Combined Excise Tax Return Form - Jan - Dec 2001
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5MAIL TO: State of Washington
Department of Revenue
JAN – DEC 2001
PO Box 34054
A
Seattle, WA 98124-1054
COMBINED EXCISE TAX RETURN
01
ONLY Fill in Box if Amended Return Information Attached
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NAME
REG NO.
FIRM NAME
STREET ADDRESS
CITY, STATE, ZIP
Address Changes?
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business location
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mailing address
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both
Business closed?
Date closed
/
/
See help section, pg 2.
Please fill in the appropriate box and make address changes to the above label.
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; Intl Charter Freight Brokers and
3
28
.00275
Stevedoring
4
14
Insurance Agents; Insurance Brokers Commis
.00484
Manuf Fresh Fruit and Veg; Split or Proc Dried Peas;
5
21
.00138
Prescription Drug Warehousing; Mfg Dairy Products
6
Processing for Hire; Printing and Publishing
10
.00484
7
07
Manufacturing
.00484
8
80
Royalties; Child Care
.00484
9
03
.00484
Wholesaling
Warehousing; Radio & TV Broadcasting; Public Road
10
11
.00484
Construction; Government Contracting
11
55
Public or Nonprofit Hospitals
.015
Cleanup of Radioactive Waste for US Gov’t;
12
83
.00471
Environmental Remedial Action
13
04
.015
Service & Other Activities
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
II STATE SALES AND USE TAX
RETAIL SALES MUST BE THE SAME
Retail Sales (also complete local tax section III)
.065
16
01
Value of articles used by taxpayer as a consumer
17
Use Tax (also complete local tax section III)
05
.065
on which no Washington sales tax has been paid
III LOCAL CITY AND/OR COUNTY SALES AND USE TAX
TOTAL STATE SALES & USE TAX
Local Sales Tax (Enter applicable rate of tax)
Code 45
JANUARY 2002
DUE DATE: JANUARY 31, 2002
Total Taxable Amount must be the same as line 16, column 3, Taxable Amount
S
M
T
W
T
F
S
31
5 % Penalty is Assessed After January 31, 2002
Line
1
2
3
4
5
No. Location Code
Taxable Amount
Local Rate
Tax Due City or Co.
10% Penalty is Assessed After February 28, 2002
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7
8
9
10
11
12
20% Penalty is Assessed After April 1, 2002
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13
14
15
16
17
18
19
If the due date falls on a weekend or legal holiday, the
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21
22
23
24
25
26
19
due date is extended to the next business day.
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28
29
30
31
20
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Please fill in this box if you had no business activity.
(See help section, pg 2.)
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This return must be mailed, unless filed electronically.
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Please make check or money order payable to the Washington
State Department of Revenue. Do not send cash or coins.
TOTAL
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TOTAL
TAXABLE
For assistance, call (800) 647-7706.
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Local Use Tax (Enter applicable rate of tax)
Code 46
Signature
Total Value of Articles must be the same as line 17, column 1, Gross Amount
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Ph. (
)
Date
Line
No. Location Code
Value of Articles
Local Rate Tax Due City or Co.
Line
Item
VIII TOTALS
No.
23
Total All Tax Due from page 1
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24
30
Total All Tax Due from page 2
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31
Rental Car Tax (attach Rental Car Tax Addendum)
TOTAL VALUE
TOTAL
OF ARTICLES
Subtotal (add lines 29-31)
32
Line
Tax
Code
Taxable Amount
Rate
Tax Due
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Credit (from page 2, section VII, total credit)
No.
Classification
Region Transit
34
Subtotal (subtract line 33 from line 32)
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89
.004
Authority (RTA)
"
Minimum
Penalty
35
$5.00
King County
.005
27
90
Food & Bev
36
Interest
Litter Tax
.00015
28
36
TOTAL AMOUNT OWED
(add lines 34 - 36)
" If you qualify, attach penalty waiver request and fill in this box
(See help section, pg 2.)
.
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REV 40 2406 A01 (10-31-01)
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