Page 1 of 2
DuPont Business License/UBI #:
Company Name:
Address:
City, State, Zip:
Email Address:
Check here if you would like to receive an email reminder and copy of the Return Form each reporting period.
Return is for quarter ending (mm/dd/yyyy):
Payment is due to City Hall by the last day of the month following the end of the quarter.
Example: 1
st
quarter returns (January 1
st
-March 31
st
) are due no later than April 30
th
.
Returns with $0 tax due (see line 3 below):
Reports must be filed by the due date.
Please note, penalties are not applicable for late returns with $0 tax due.
Returns with Gross Taxable Receipts (line 2) greater than or equal to $5,000, with tax due (line 3):
Reports must be filed by the due date.
If a payment is due, and it is not paid by the due date, a penalty will be assessed as
follows:
1 to 30 days delinquent - 9% of tax due, no less than $5.00
31 to 60 days delinquent - 19% of tax due, no less than $5.00
61+ days delinquent - 29% of tax due, no less than $5.00
1) Type of business :
Construction/ Repair/ Landscape Financial Institutions
Manufacturing/ Extracting Non-profit
Retail Nursery/ School/ Childcare
Services Utilities
Wholesale Automotive Sales/ Leasing
Other
2) Gross Taxable Receipts: $
(for business conducted in the City of DuPont only):
Business & Occupation Tax
Return (Ordinance No. 08-867)
Please type or print.
For annual filing place year only.
Page 2 of 2
3) Tax Due (line 2 times .001): $
4) Penalty (see penalty schedule above): $
5) Total Tax Due (Lines 3 + Line 4): $
Returns are due each reporting period for all active accounts. If you are no longer conducting business in the City of
DuPont and wish to close your City of DuPont account, please check below & list the effective date:
We no longer conduct business within the City of DuPont effective:
(date)
Prepared by: Title:
Name (please print )
Email: Phone:
Signature: Date:
Instructions
Please print the return form and complete as instructed below:
Line 1: Check the appropriate box that most accurately describes your business.
Line 2: Enter the total gross taxable receipts ($), for business conducted in the City of DuPont only.
Line 3: If your gross taxable receipts are less than $5,000 for the reporting period, no tax is due, enter
$0 on this line. If your gross taxable receipts are more than $5,000 for the reporting period, multiply
the amount ($) on “Line 2” times .001, and enter the calculated amount.
Line 4: Payment is due to City Hall by the close of business the last day of the month following the end
of the period. Any payments received after the due date* will be assessed a minimum penalty of $5, or
a percentage of the tax due (whichever is greater) as follows:
1 to 30 days delinquent- 9% of
tax due, or $5 (whichever is greater)
31 to 60 days delinquent- 19% of tax due, or $5 (whichever is greater)
61 + days delinquent- 29% of tax due, or $5 (whichever is greater)
Line 5: Add “Line 3+ “Line 4”, enter total. This
is the total payment due. Please remit to the City of
DuPont.
* Please note, if no tax is owed, a return must still be filed.
Returns filed late, but with $0 tax due, are not subject to a late fee.
Returns with $0 payment due may b
e submitted electronically by email
to: Businesstaxes@dupontwa.gov or faxed to 253-964-3554.
All returns/ paymen
ts may be delivered to:
City of DuPont, 1700 Civic
Drive, DuPont, WA 98327