Multi-Purpose Combined Excise Tax Return Form - Washington Department Of Revenue
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5State of Washington
Period
Year
Department of Revenue
PO Box 34052
Seattle, WA 98124-1052
MULTI-PURPOSE COMBINED EXCISE TAX RETURN
Fill in Box if Amended/Supplemental Return or Correspondence is Attached
!
NAME
REG NO.
FIRM NAME
STREET ADDRESS
CITY, STATE, ZIP
Please make any address changes above. Fill in box if this change is
!
If your business closed, fill in the box
and
your ! business location, ! mailing address, or ! both.
indicate date:___/___/____. See note 5, page 2.
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
Extracting, Extracting for Hire
.00484
1
16
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
Insurance Agents/Insurance Brokers Commis
14
.00484
Manufacturing Fresh Fruits and Vegetables; Splitting or
5
21
.00138
Proc Dried Peas
6
Processing for Hire/Printing and Publishing
10
.00484
Manufacturing
.00484
7
07
8
Royalties; Child Care
80
.00484
9
03
.00484
Wholesaling
Warehousing, Radio & TV Broadcasting, Public Road
10
11
.00484
Construction/Government Contracting
11
Public or Nonprofit Hospitals
55
.015
Cleanup of Radioactive Waste for US Gov’t;
.00471
12
83
Environmental Remedial Action
.015
13
04
Service & Other Activities
14
Retailing of Interstate Transportation Equip
19
.00484
15
Retailing
02
.00471
TOTAL B&O TAX
* Deductions taken but not itemized on pages 3 and 4 will be disallowed.
GROSS AMOUNTS FOR RETAILING AND
II STATE SALES AND USE TAX
RETAIL SALES MUST BE THE SAME
16
Retail Sales (also complete local tax section)
01
.065
Value of articles used by taxpayer as a consumer
Use Tax (also complete local tax section)
.065
17
05
on which no Washington sales tax has been paid
TOTAL STATE SALES & USE TAX
LOCAL CITY AND/OR COUNTY SALES AND USE TAX
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!
Please check (
) this box if you had no business activity.
Local Sales Tax (Enter applicable rate of tax)
Code 45
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This return must be filed even if no tax is due.
Total Taxable Amount must be the same as line 16, column 3, Taxable Amount
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Line
If filing Amended Return, compute penalty ONLY if original return was
No. Location Code
Taxable Amount
Rate
Tax Due City or Co.
assessed a penalty .
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18
Please make check or money order payable to the Washington State
Department of Revenue. Do not send cash or coins.
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! ! ! !
For assistance, call (800) 647-7706.
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! ! ! !
Signature
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! ! ! !
Ph. (
)
Date
22
TOTAL
5% Penalty Due After Due Date
TAXABLE
TOTAL
10% Penalty Due After the Last Day of the Month Following the Due Date
20% Penalty Due After the Last Day of the Second Month Following the Due Date
Local Use Tax (Enter applicable rate of tax)
Code 46
If the due date falls on a weekend or legal holiday, the due date for the
Total Value of Articles must be the same as line 17, column 1, Gross Amount
return is extended to the next business day.
Line
No. Location Code
Value of Articles
Rate
Tax Due City or Co.
Line
Item
VII TOTALS
No.
23
29
Total All Tax Due from page 1
24
Total All Tax Due from page 2
30
25
31
Rental Car Tax (attach Rental Car Tax Addendum)
TOTAL VALUE
TOTAL
OF ARTICLES
32
Subtotal (add lines 29-31)
Line
Tax
Credit (from page 2, section VI, total credit)
33
Code
Taxable Amount
Rate
Tax Due
No.
Classification
34
Subtotal (subtract line 33 from line 32)
Region Transit
89
26
.004
Minimum
Authority (RTA)
35
(see note number 4 on page 2)
Penalty
$5.00
King County
27
90
.005
36
Interest
Food & Bev
TOTAL AMOUNT OWED (ADD LINES 34 - 36)
28
Litter Tax
36
.00015
Please check (!) if you prefer a " Credit or " Refund.
REV 40 2406 MULTI-JAN2000 (01-20-00) (Use for January 1, 2000 forward)
Page 1
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