Oil Spill Tax Return - Washington Department Of Revenue - 2010
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Washington State
August 2010
08
Department of Revenue
Taxpayer Account Administration
PO Box 47464
10
Print This Form
Olympia WA 98504-7464
OIL SPILL TAX RETURN
ONLY Fill in Box if Amended/Supplemental Return Information is Attached
Address Changes?
business location
mailing address
both
Business closed?
Date closed ____/____/____
Please fill in the appropriate box and make address changes to above label.
Taxpayers with Direct Pay Certificates and Marine Terminal Operators
Receiving for Themselves or for Others Report Here
INSTRUCTIONS
Line
No. of Barrels
Tax Rate
Tax Due
Marine Terminal Operators or Taxpayers with
No.
Direct Pay Certificates
1
.04
Enter the total number of barrels of crude oil or
Export Credit: Amount of Tax Claimed as Credit Where You paid the Tax
petroleum products first received in Washington
Line
Total No. of Barrels
Tax Rate
Export Credit
No.
Exported
Paid
from a waterborne vessel or barge on which you
2
.04
are paying the tax this month. Multiply the
3
.05
barrels received by the tax rate shown to get the
amount of tax.
Total Export Credit
Export Credit: Amount of Tax Claimed as Credit Where a Previous Owner
Credits for Export
Paid the Tax
If you exported crude oil or petroleum products
Line
Total No. of Barrels
Tax Rate
Export Credit
on which you already paid this tax, enter the
No.
Exported
Paid
number of barrels on lines 2 & 3 corresponding
4
.04
to the tax rate paid. If you exported crude oil or
5
.05
petroleum products on which a previous owner
Total Export Credit
already paid this tax, enter the number of barrels
Credit for Consumption or When Used as a Component to Manufacture a
on lines 4 and 5 corresponding to the tax rate
Non-Fuel Item
paid.
Line
Tax Rate
No. of Barrels
Total Other Credit
No.
Paid
Credits for Consumption or Manufacturing
6
.04
Component
7
.05
For previously taxed oil or petroleum products
Total Other Credit
which you used as a consumer for a purpose
September 25, 2010
DUE DATE:
other than as a fuel, or you used as a component
September 27, 2010
or ingredient in the manufacture of an item which
5% Penalty Assessed After
November 1, 2010
15% Penalty Assessed After
is not a fuel, enter the number of barrels on lines
November 30, 2010
25% Penalty Assessed After
6 and 7 corresponding to the tax rate paid.
If the due date falls on a weekend or legal holiday,
the due date is extended to the next business day.
Credit Return
4
Please fill in this box if you had no business activity.
If the result of your tax due calculation is a credit,
4
For assistance, call (360) 902-7034.
we will send you a credit notice. Credit notices
4
Signature
may be used to offset future oil spill tax liabilities,
4
Ph. (
)
Date
or you may request a refund.
Totals
Payment
Line
Description
Totals
No.
Make your check or money order payable to the
+
8
Tax Due (from line 1)
Washington State Department of Revenue and
–
9
Total Oil Spill Credits (add lines 2, 3, 4, 5, 6 & 7)
mail to the Washington State Department of
=
10
Total Tax (subtract line 9 from line 8)
Revenue, PO Box 47464, Olympia WA 98504-
–
7464.
11
Credit Notices Applied (attach Credit Notice)
=
12
Tax Due (subtract line 11 from line 10)
For tax assistance, visit dor.wa.gov or call 1-800-647-7706.
MINIMUM
To inquire about the availability of this document in an
+
13
Penalty*
$5.00
alternate format for the visually impaired, please call (360)
=
14
Total Payment Enclosed** (add lines 12 through 13)
705-6715. Teletype (TTY) users please call 1-800-451-7985.
** Do not pay this tax with your Combined Excise Tax Return
If you qualify, attach penalty waiver request and fill in box
REV 41 0066
(8/4/10)
.
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