"Quarterly Utility Tax Return Form" - City of Blaine, Washington

This fillable "Quarterly Utility Tax Return Form" is a document issued by the City of Blaine Finance Department specifically for Washington residents.

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Download "Quarterly Utility Tax Return Form" - City of Blaine, Washington

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City of Blaine
“THE PEACE ARCH CITY”
344 “H” Street
Blaine, WA 98230
360-332-8311 Fax 360-332-8330
QUARTERLY UTILITY TAX RETURN
Quarter
______________________________________________________________________
Name of Business
______________________________________________________________________
Mailing Address
______________________________________________________________________
Business Address
______________________________________________________________________
Telephone No.
__________________________ e-mail Address _______________________________
City of Blaine Business License No.
_________________________
Type of Utility
_____________________________________
Tax Computation
1. Total Gross Receipts
$_______________________
(For telephone utility adjusted gross receipts)
2. Taxing Rate - 6% Non Cable
___________%
- 5% Cable (Franchise Fees)
3. Total Current Tax Due - Multiply line 1 by line 2
$______________________
4. Penalty Rate - Tax is due the last day of the month following
the end of the quarter
___________%
10% 1-30 days past due
20% 31-60 days past due
30% 61 or more days past due
5. Penalty For Late Payment - Multiply line 3 by line 4
$______________________
due dates – Apr 30, Jul 31, Oct 31, Jan 31
6. Total Tax Due - Add line 3 and line 5
$______________________
Certification
The undersigned taxpayer declares that he/she has read the foregoing return and certifies it to be true, accurate
and complete.
Authorized Representative
_________________________
_______________________
Signature
Date
_________________________ _________________________ (______)__________________
Print Name
Title
Telephone No.
CONFIDENTIAL - The information on this tax return will not be released to the public.
f:\users\ematlewsky\eden\taxes\utility\utilfrm.doc
City of Blaine
“THE PEACE ARCH CITY”
344 “H” Street
Blaine, WA 98230
360-332-8311 Fax 360-332-8330
QUARTERLY UTILITY TAX RETURN
Quarter
______________________________________________________________________
Name of Business
______________________________________________________________________
Mailing Address
______________________________________________________________________
Business Address
______________________________________________________________________
Telephone No.
__________________________ e-mail Address _______________________________
City of Blaine Business License No.
_________________________
Type of Utility
_____________________________________
Tax Computation
1. Total Gross Receipts
$_______________________
(For telephone utility adjusted gross receipts)
2. Taxing Rate - 6% Non Cable
___________%
- 5% Cable (Franchise Fees)
3. Total Current Tax Due - Multiply line 1 by line 2
$______________________
4. Penalty Rate - Tax is due the last day of the month following
the end of the quarter
___________%
10% 1-30 days past due
20% 31-60 days past due
30% 61 or more days past due
5. Penalty For Late Payment - Multiply line 3 by line 4
$______________________
due dates – Apr 30, Jul 31, Oct 31, Jan 31
6. Total Tax Due - Add line 3 and line 5
$______________________
Certification
The undersigned taxpayer declares that he/she has read the foregoing return and certifies it to be true, accurate
and complete.
Authorized Representative
_________________________
_______________________
Signature
Date
_________________________ _________________________ (______)__________________
Print Name
Title
Telephone No.
CONFIDENTIAL - The information on this tax return will not be released to the public.
f:\users\ematlewsky\eden\taxes\utility\utilfrm.doc
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