QUARTERLY
                                                                                                                 Business and Occupation       Tax  Report 
                                                                                                                     (OMC Ordinance 2923 as   amended)

                                                                                                Business             Statement
                                                                                                                                              Period                  Date Due
                                                                                                Number                Number

Bus. Name 
DBA Name
Address                                                                                                     If Final Return. Date  Business    Closed: 
City, St. Zip 

       Column 1                 Column 2                 Column 3                   Column 4     Column 5                                     Column 6 
                                                     Deductions
       Business                                      from worksheet                 Taxable                                              Tax Amount 
    Classification           Gross Amount                on Page  2            Gross Amount           Rate                                        Due
Road Const
or Extraction                                                                                        .00100
Retailing                                                                                            .00100

Wholesaling                                                                                          .00100

Manufacturing                                                                                        .00100
Printing &
Publishing                                                                                           .00100
Service &
Other Activity                                                                                       .00200
Retail Service                                                                                       .00100

                                                                                                            STATEMENT TOTAL

                                                                                                                          PENALTY

                                                                                                            PREVIOUS BALANCE

                                                                                                            TOTAL AMOUNT     DUE 

                                                                                                                      Make checks payable         to: 
IF TOTAL      TAXABLE     AMOUNT          IN   COLUMN 4 IS     LESS THAN      $5,000.00,     NO                              City Treasurer 
                       TAX IS   DUE, BUT      REPORT     MUST     BE FILED.                                                  PO Box   2009 
                                                                                                                      Olympia, WA 98507        2009‐
                                                                                                                      Phone: (360) 753   8327‐
    **PENALTIES:No penalty         on     payments   received     on or before   the          
    last day of   the month  in which     the tax is due.                                                   The undersigned taxpayer declares that they     have read 
                                                                                                            the foregoing return and certifies it to     be correct. 
    9%of the   tax due if not   received  on or   before   the last day of the              
    month in   which the  tax   is due.   
                                                                                               Dated this            day of                                          Year
    19%of the     tax due if not   received   on or  before   the last day of the             
    month following    the   due   date. 
    29% of the    tax due if not   received   on or  before   the last day of the               Firm Name:
    second month      following    the due date. 
    Minimum penalty       on all   late returns   where    tax is due   is $5.00.               Signature:
    There   is no penalty on late  returns     with  no tax   due.                                    Title:
                                                                                                    Phone:
                                                                                                     Email:

                               WORKSHEET 
                                       
 Type of         MFG WHOLESALE RETAIL           PRINTING / PUBLIC ROAD    SVC AND                        RETAIL 
 Deduction                                      PUBLISHING CONST/         OTHER ACT              SERVICE 
                                                           EXTRACTING 
 Bad Debts              

 Cash and               
 Trade Discounts 

 Interstate             

 Motor Vehicle          
 Fuel Sale 

 Liquor, Wine,          
 Beer 

 Total Business         
 Deductions 

TRANSFER THESE TOTALS TO OTHER SIDE ON COLUMN 3 
 
                           EXPLANATION OF CATEGORIES: 
                                       
 MANUFACTURING -           every person who, either directly or by contracting with others for the necessary 
                           labor or mechanical services, manufactures for sale or commercial use from his 
                           own materials or ingredients any articles, substances or commodities. 

 WHOLESALE -               every person engaging in the business of making sales at wholesale of articles, 
                           commodities or merchandise held for sale or to be delivered within the city. 

 RETAIL -                  every person engaging in the business of making sales at retail of  articles, 
                           commodities or merchandise held for sale or to be delivered within the city, 
                           including competitive telephone service; sales of the business without regard to 
                           the place of delivery of articles, commodities or merchandise sold. 

 PRINTING AND PUBLISHING - every person engaging in the business of printing and of .publication within this 
                           city of newspapers, periodicals or magazines. 

 PUBLIC ROAD               building, repairing or improving any publicly owned street, place, road, highway, 
 CONSTRUCTION/             bridge or trestle within this city which is used, or to be used, primarily for foot or 
 EXTRACTING -              vehicular traffic; every person, directly or by contracting with others, removing any 
                           mineral or other natural resource product from his or her own land or from land of 
                           another under a right or license granted by lease or contract. 

 SERVICE AND               every person engaging in any business venture other than those specified above. 
 OTHER ACTIVITIES -  

 RETAIL SERVICE -          shall include the sale of or charge made for personal, business, or professional 
                           services including amounts designated as interest. rents, fees, admission, and 
                           other service emoluments however designated. These include, but are not limited 
                           to credit bureau services, landscape maintenance, physical fitness services, 
                           tanning salon services and automobile parking.