Combined Excise Tax Return Form - Washington State Department Of Revenue - 2013
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4MAIL TO:
Washington State
July - Aug - Sept 2013
Department of Revenue
Q3
PO Box 47464
Olympia WA 98504-7464
13
Combined Excise Tax Return
If you have no business activity, check the box and mail this return
(unless filed electronically)
NAME
TAX REG NO.
BUSINESS NAME
STREET ADDRESS
CITY, STATE, ZIP
Address Changes?
Business Location
Mailing Address
Business Closed?
Other Correspondence?
Date Closed ___/___/___ See Additional Information, pg 2
Effective date of change ___/___/___
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; Soybean & Canola Proc
Travel Agent Com/Tour Operators; Intl Charter Freight
3
28
.00275
Brokers; Stevedoring; Assisted Living Facilities
Insurance Producers; Title Insurance Agents;
4
14
.00484
Surplus Line Broker Commissions
Prescription Drug Warehousing; Mfg: Wood Biomass
5
21
.00138
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
Wholesaling
03
.00484
Warehousing; Radio & TV Broadcasting; Public Rd Const; Gov
10
11
.00484
Contracting; Chem Dependency Ctr; Canned Salmon Labelers
11
55
.015
Public or Nonprofit Hospitals; Qualified Food Co-ops
12
83
Cleanup of Radioactive Waste for US Gov
.00471
Service & Other Activities and/or Gambling Contests of
13
04
.015
Chance (less than $50,000 a year)
14
192
Gambling Contests of Chance ($50,000 a year or greater)
.0163
15
For Profit Hospitals; Scientific R&D
135
.015
16
Retailing of Interstate Transportation Equip
19
.00484
17
02
Retailing
.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
18
Retail Sales (also complete local tax section III)
01
.065
Use Tax/Deferred Sales Tax (also complete local tax
Value of articles used by taxpayer as a consumer
19
05
.065
on which no Washington sales tax has been paid
section III)
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
Filing an Amended Return?
Check this box and attach a letter of explanation.
Total Taxable Amount must be the same as line 18, column 3, Taxable Amount
Line
DUE DATE: October 31, 2013
Location Code
Taxable Amount
Local Rate
Tax Due City or Co.
No.
5% Penalty Assessed After October 31, 2013
20
15% Penalty Assessed After December 02, 2013
21
25% Penalty Assessed After December 31, 2013
If the due date falls on a weekend or legal holiday,
22
the due date is extended to the next business day.
23
Please make check or money order payable to the Washington State Department of
TOTAL
TOTAL
Revenue. Include your tax registration number on your check.
TAXABLE
Signature
Local Use Tax/Deferred Sales Tax (Enter applicable rate of tax.) Code 46
Print Name
Total Value of Articles must be the same as line 19, column 1, Gross Amount
Ph. (
)
Date
Line
Location Code
Value of Articles
Local Rate
Tax Due City or Co.
No.
Line
Item
VII TOTALS
No.
24
28
Total All Tax Due from page 1
25
29
Total All Tax Due from page 2
TOTAL VALUE
TOTAL
OF ARTICLES
30
Total All Addendums (example: Rental Car Addendum)
31
Subtotal (add lines 28-30)
Line
Tax
Code
Taxable Amount
Rate
Tax Due
No.
Classification
32
Credit (from page 2, section VI, total credit)
Motor Vehicle
26
120
.003
33
Subtotal (subtract line 32 from line 31)
Sales/Leases
Litter Tax
27
36
34
.00015
Add Penalty, if applicable
Minimum $5.00
TOTAL AMOUNT OWED (add lines 33 - 34)
Internet/Fax
Penalty waiver request? Attach and fill in box.
(See Additional Information, pg 2)
(7-30-13)
Page 1
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