State of Washington Department of Revenue PO Box 47464 Olympia, WA 98504-7464 Posting Period Office Use Only CONSUMER USE TAX RETURN Please note the following: Ø If you have a current business registration with the Department of Revenue, report use tax for businessrelated purchases on the Combined Excise Tax Return for the next reporting period. Ø To pay use tax on automobiles, vessels, or airplanes, please contact one of our local field offices or call 1-800-647-7706 for further assistance. Ø To determine your appropriate location code and *tax rate, see www.dor.wa.gov, select Services Hot Button, select GIS (Geographic Information System) or call 1-800-647-7706 for assistance. For information about use tax, select Publications Hot Button, select Business Taxes, and then select Use Tax. Complete the following: Full Name Address City, State, Zip General Description of Items Purchased (optional) Value of Items $ 4 Make check payable to: Total Value Department of Revenue 4 Mail return and check to: Department of Revenue PO Box 47464 Olympia WA 98504-7464 Location Code * Tax Rate X Total Use Tax (Total Value x Tax Rate) $ Signature Phone ( ) Date To inquire about the availability of this notice in an alternate format for the visually impaired or in a language other than English, please call (360) 753-3217. Teletype (TTY) users may call (800) 451-7985. You may also access tax information on our Internet web site at http://dor.wa.gov. REV 83 2501B (8-12-99) LPB 72-05 American LegalNet, Inc. www.FormsWorkflow.com
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