Combined Excise Tax Return Form - Washington State Department Of Revenue - 2010
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4MAIL TO:
Washington State
April 2010
Department of Revenue
04
PO Box 34051
Seattle WA 98124-1051
Combined Excise Tax Return
10
Filing an Amended Return? Check this box and attach a letter of explanation.
NAME
TAX REG
NO.
BUSINESS NAME
STREET ADDRESS
CITY, STATE, ZIP
Address Changes?
Business location
Mailing address
Business closed?
Date closed ___/___/___ See Help section, pg 2.
Other Correspondence?
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; Licensed Boarding Homes
Insurance Producers; Title Insurance Agents;
4
14
.00484
Surplus Line Broker Commissions
Prescription Drug Warehousing; Mfg: Bio/Alcohol Fuel,
5
21
.00138
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; Gov
10
11
.00484
Contracting; Chem Dependency Ctr; Canned Salmon Labelers
11
55
Public or Nonprofit Hospitals
.015
12
83
Cleanup of Radioactive Waste for US Gov
.00471
Service & Other Activities and/or Gambling Contests
13
04
.015
of Chance (less than $50,000 a year)
14
192
.0163
Gambling Contests of Chance ($50,000 a year or greater)
15
19
Retailing of Interstate Transportation Equip
.00484
16
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
17
01
Retail Sales (also complete local tax section III)
.065
Use Tax/Deferred Sales Tax (also complete
Value of articles used by taxpayer as a consumer
18
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
If you have no business activity, check the box and
Local Sales Tax (Enter applicable rate of tax.)
Code 45
Total Taxable Amount must be the same as line 17, column 3, Taxable Amount
mail this return (unless filed electronically)
Line
Location Code
Taxable Amount
Local Rate
Tax Due City or Co.
DUE DATE: May 25, 2010
No.
19
5% Penalty Assessed After May 25, 2010
15% Penalty Assessed After June 30, 2010
20
25% Penalty Assessed After August 02, 2010
21
If the due date falls on a weekend or legal holiday,
22
the due date is extended to the next business day.
TOTAL
4
Please make check or money order payable to the Washington State Department of
TOTAL
TAXABLE
Revenue. Include your tax registration number on your check.
Local Use Tax/Deferred Sales Tax (Enter applicable rate of tax.) Code 46
4
Signature
Total Value of Articles must be the same as line 18, column 1, Gross Amount
4
Print Name
Line
Location Code
Value of Articles
Local Rate Tax Due City or Co.
No.
4
Ph. (
)
Date
23
Line
Item
VII TOTALS
24
No.
TOTAL VALUE
28
Total All Tax Due from page 1
TOTAL
OF ARTICLES
29
Total All Tax Due from page 2
Line
Tax
Code
Taxable Amount
Rate
Tax Due
No.
Classification
30
Total All Addendums (example: Rental Car Addendum)
Motor Vehicle
25
120
.003
31
Subtotal (add lines 28-30)
Sales/Leases
King County
32
Credit (from page 2, section VI, total credit)
26
90
.005
Food & Bev
33
Subtotal (subtract line 32 from line 31)
Litter Tax
27
36
.00015
34
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 Help section, pg 2)
(4-21-10)
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