210 W 6th Avenue * PO Box 6108 * Kennewick, WA 99336-0108 Phone (509) 585-4266 * Fax (509) 585-4383
GAMBLING TAX RETURN
The tax levied on gambling activity shall be paid quarterly for the preceding three month period on or before the 31st day of January, the 30th day of April, the 31st day of July and the 31st day of October at the office of the Support Services Director as specified in Kennewick Municipal Code 3.60.040. PENALTIES AND INTEREST MAY BE ASSESSED ON THE
FIRST DAY FOLLOWING THE DUE DATE.
Name of Business Business Address Mailing Address ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ State Gambling License No. ___________________________________ TAX LEVIES I. Punchboard/Pull Tabs: Gross Receipts Less Amount Paid as Prizes Net Receipts Tax Due (Net Receipts X .10) ____________________ (____________________ ) ____________________ ____________________ ____________________ (____________________ ) ____________________ ____________________ ____________________ ____________________ ____________________ (____________________ ) ____________________ ____________________ _____________________ PENALTIES I. Late Penalty - 50% of tax due ____________________ ____________________ _____________________ _____________________
II. Bingo Games: Gross Receipts Less Amount Paid as Prizes Net Receipts Tax Due (Net Receipts X .05) III. Card Rooms: Gross Receipts Tax Due (Gross Receipts X .10) IV. Amusement Games: Gross Receipts Less Prizes Net Receipts Tax Due (Net Receipts X .02) TAX DUE
II. Interest - 1% of all taxes and penalties due for each month delinquent or portion thereof. PENALTIES DUE TOTAL TAX AND PENALTIES DUE
I declare under the penalties of perjury that this return, including any accompanying schedules and statements, has been examined by me and to the best of my knowledge is a true, correct, and complete return. Signature and Title ___________________________________________________________ Date _________________
A COPY OF YOUR WASHINGTON STATE GAMBLING COMMISSION REPORT MUST BE ATTACHED.