ANNUAL
                                                                                                                 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     $20,000.00,     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. 
                                                                                                Signature:
    Minimum penalty on       all   late returns   where     tax is due   is $5.00.          
    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.