Use this form to report and pay use tax on items you pur-
chased that didn’t include Washington sales tax.
Consumer use tax return
1. Write the name of the business where you
purchased your items in column A.
2. Click the Find a sales and use tax rate link on our
home page, dor.wa.gov to nd your location
code and tax rate.
• Enter location code in column B.
• Enter rate in column D.
Or, go to dor.wa.gov/taxratelookup.
* The location code refers to the address where
you rst used the item in Washington (usually
your home).
Your information
Name: ___________________________________________________Phone: _____________________
Address: ______________________________________ City:_____________State:_____Zip: ________
Signature: ________________________________________________Date: ______________________
For tax assistance or to inquire about the availability of this document in an alternate format, please call 360-705-6705.
Teletype (TTY) users may use the Washington Relay Service by calling 711.
A B C D E
Name of seller Location
code*
Total value
(Include shipping)
Tax rate Tax due
Example: Business name 3406 $ 45 x .089 = $ 4.01
$ x = $
$ x = $
$ x = $
$ x = $
$ x = $
$ x = $
$ x = $
$ x = $
$ x = $
$ x = $
Total value of purchases $ Total use tax
$
Do not use this form if you are:
• A registered business. Please report use tax on your tax return.
• Reporting use tax on automobiles, vessels, or airplanes. To pay visit your local Revenue or vehicle licensing oce.
OFFICE USE ONLY
/
3. Enter the price or value of your purchased item(s)
including the shipping charges in column C
4. Calculate the tax you owe by multipling C x D.
5. Add column E for total use tax due.
6.
Mail this form with your payment.
Make check payable to:
Washington State Department of Revenue
PO Box 94481
Seattle, WA 98124-6781
Questions? Call us at 360-705-6705.
REV 40 2412 (6/24/19)
