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' C t4;14C)Z '-- CD° r-4'.' <br /> 04 CLERK TREASURER <br /> 2930 WETMORE AVE STE 1A <br /> EVERETT, WA. 98201-4067 <br /> 425-257-8614 City of Everett <br /> Sale 1 MULTI-PURPOSE TAX '2-1- rr <br /> 4th Quarter or Annual Filing <br /> xxxxxxxxxxxx5331 <br /> VISA Entry Method: ChiP Date Due Reporting Period Account# <br /> y $ Ending <br /> Total:otal: 4L 50 MM/DD/YYYY <br /> 08/06/191/31/2019 12/31/2018 57667 <br /> Inv it. 000000001 Appr Code: 110396 RECEIVE ,APPrvd: Online <br /> /ISA DEBIT i AUG 0 6 2019 <br /> Y 80 80A0000000031010 <br /> 00 8O 00 OF EVERETT <br /> �uR; CITY <br /> SI; 68 00 <br /> City Clerk <br /> Customer COPY <br /> THANK YOU! <br /> jation Tax—WORLDWIDE GROSS RECEIPTS <br /> Issuer accodi6g to their <br /> Code Column 2 Column 3 Column 4 Column 5 Column 6 <br /> Psvment terms. Gross Receipts Deductions*Sch.D Taxable Receipts Tax Rate Tax Due • <br /> Customer Copy 02 0.001 <br /> o3,. 7 5(c) M /S (me q.eic 0 0.001 <br /> ee <br /> THANK YOU! ftioned) 06 / s 0.001 <br /> 'ed) 12 Use Schedule A--=---- ♦ 0.001 <br /> ;�.... _. .,, •v for Hire 01 0.001 <br /> 6 Printing/Publishing 04 0.001 <br /> 7 Extracting/Extracting for Hire 11 0.001 <br /> 8 Less Multiple Activities Tax Credit* 20 Use Schedule C--------- <br /> 9 <br /> -------9 Taxable Receipts Subtotal------------------------------------------------- .IIN- Subtotal <br /> (If taxable receipts are less than or equal to$5,000 for quarterly filers or$20,000 for annual filers,then no Gross Receipts Tax is due) <br /> Section 2: Utility Taxes(Due Monthly) <br /> 10 Telephone 40 0.060 <br /> 11 Natural Gas 42 0.060 <br /> 12 Electricity 43 0.060 <br /> 13 Cable TV 44 . • 0.060 <br /> 14 Garbage 46 0.060 <br /> 15 Utility Tax Subtotal----------------------------------------- - <br /> —---------------------------- ----- ♦ Subtotal <br /> Section 3: Other Taxes (Due Quarterly) <br /> 16 Amusement Games - 60 0.020 <br /> 17 Pull Tabs/Punch boards i' 61. 0.040 <br /> 18 Bingo : 62 0.035 <br /> 19 Raffles 63 0.035 <br /> 20 Admissions 64 0.050 <br /> 21 Other Taxes Subtotal ----------- <br /> -- -- ---- ♦ Subtotal <br /> Section 4:Annual Renewal General Business License(Required) <br /> 22 Business License Renewal Fee 88 Please add to your Tax&License Subtotal below e423"18-- Lt 1 , <br /> *Deductions require SCHEDULE D to be enclosed.Forms are available on everettwa.gov/businesstax Tax&License Subtotal <br /> Account Balance <br /> Tax Penalty(see back) <br /> Prepared by:Name(please print) Title----------------- -----Phone License Penalty(see back) <br /> Interest(see back) <br /> Total Due <br /> I hereby certify that the statements and information provided on this tax return are true and complete to the best of my knowledge. <br /> Signature Date Phone Email <br />