Form Q2/02 - Combined Excise Tax Return Form - 2002
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5MAIL TO: State of Washington
Department of Revenue
APR - MAY - JUN 2002
PO Box 34054
Q2
Seattle, WA 98124-1054
COMBINED EXCISE TAX RETURN
02
ONLY Fill in Box if Amended Return Information Attached
!
NAME
REG NO.
FIRM NAME
STREET ADDRESS
CITY, STATE, ZIP
Address Changes?
business location
mailing address
both
Business closed?
Date closed ___/___/___ See note section, pg 2.
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Please fill in the appropriate box and note address changes above.
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/Tour Operators; Intl Charter Freight
3
28
.00275
Brokers; 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
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 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
Service & Other Activities
.015
14
19
Retailing of Interstate Transportation Equip
.00484
15
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
16
Retail Sales (also complete local tax section III)
01
.065
Use Tax/Deferred Sales Tax (also complete
Value of articles used by taxpayer as a consumer
17
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
DUE DATE: JULY 31, 2002
JULY 2002
31
Local Sales Tax (Enter applicable rate of tax)
Code 45
S
M
T
W
T
F
S
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5% Penalty Assessed After July 31, 2002
Total Taxable Amount must be the same as line 16, column 3, Taxable Amount
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2
3
4
5
6
10% Penalty Assessed After September 3, 2002
Line
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8
9
10
11
12
13
20% Penalty Assessed After September 30, 2002
No. Location Code
Taxable Amount
Local Rate
Tax Due City or Co.
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15
16
17
18
19
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If the due date falls on a weekend or legal holiday,
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22
23
24
25
26
27
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the due date is extended to the next business day.
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29
30
31
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Please fill in this box if you had no business activity.
(see note section, page 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
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State Department of Revenue. Do not send cash or coins.
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For assistance, call (800) 647-7706.
TOTAL
TOTAL
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TAXABLE
Signature
Local Use Tax/Deferred Sales Tax (Enter applicable rate of tax)
Code 46
Ph. (
)
4 4 4 4
Date
Total Value of Articles must be the same as line 17, column 1, Gross Amount
Line
Item
VIII TOTALS
Line
No.
No. Location Code
Value of Articles
Local Rate Tax Due City or Co.
29
Total All Tax Due from page 1
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30
Total All Tax Due from page 2
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31
Rental Car Tax (attach Rental Car Tax Addendum)
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32
Subtotal (add lines 29-31)
TOTAL VALUE
TOTAL
OF ARTICLES
33
Credit (from page 2, section VII, total credit)
Line
Tax
Code
Taxable Amount
Rate
Tax Due
No.
34
Subtotal (subtract line 33 from line 32)
Classification
Region Transit
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Minimum
26
89
.004
35
Add Penalty, if applicable
$5.00
Authority (RTA)
King County
36
Interest
27
90
.005
Food & Bev
TOTAL AMOUNT OWED
(add lines 34 - 36)
28
36
Litter Tax
.00015
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If you qualify, attach penalty waiver request and fill in box
(see note section, page 2)
REV 40 2406 Q2/02 (5-06-02)
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