Lodging Addendum — Form & Instructions

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(10-17-19) Lodging Addendum Use Black Ink and Attach this Original Addendum to Your Combined Excise Tax Return.4 Name: Account ID Note: Please see the Lodging Information Rates and Changes flyer for current location codes and tax rates. Lodging Taxes Note: Transient Rental Income Information MUST be completed if you are remitting Convention and Trade Center or Special Hotel/Motel tax. Transient Rental Income Information [47] (enter location code and income only) Convention and Trade Center Tax [48] Special Hotel/Motel Tax [70] 1. 7. 12. 8. 13. 9. 14. 10. 15. 4. 2. 5. 3. 6. Income Taxable Amount Taxable Amount Taxable Amount Taxable Amount Taxable Amount Taxable Amount Taxable Amount Taxable Amount Tax Due Tax Due Tax Due Tax Due Tax Due Tax Due Tax Due Tax Due Rate Rate Rate Rate Rate Rate Rate Rate Income Income Income Income Income Location Code Location Code Location Code Location Code Location Code Location Code Location Code Location Code Location Code Location Code Location Code Location Code Location Code Location Code , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , ,, , , , , , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . x x x x x x x x = = = = = = = = 16. Total Special Hotel/Motel Tax Due (Add tax due, lines 12-15) 11. Total Convention & Trade Center Tax Due (Add tax due, lines 7-10) 17. Total Lodging Taxes (Add lines 11, 16 and 26) Reminder: Attach this addendum to your original return and mail to the Department. Add all Addendum totals and transfer the amount to the Total All Addendums line on your tax return. Internet/Fax Period Year

(10-17-19) Lodging Addendum Use Black Ink and Attach this Original Addendum to Your Combined Excise Tax Return.4 Name: Account ID Lodging Charges Note: See the Lodging Charge Special Notice for your county's rates on our web site at dor.wa.gov. Tourism Promotion Area Lodging Charge [170] 18. 19. 20. 21. 22. 23. 24. 25. Total Charges Due Total Charges Due Total Charges Due Total Charges Due Total Charges Due Total Charges Due Total Charges Due Total Charges Due Unit/Day Rate Charged Unit/Day Rate Charged Unit/Day Rate Charged Unit/Day Rate Charged Unit/Day Rate Charged Unit/Day Rate Charged Unit/Day Rate Charged Unit/Day Rate Charged Location Code Location Code Location Code Location Code Location Code Location Code Location Code Location Code Number of Unit/Days Number of Unit/Days Number of Unit/Days Number of Unit/Days Number of Unit/Days Number of Unit/Days Number of Unit/Days Number of Unit/Days , , , , , , , , , . . . . . . . . . . . . . . . . . x x x x x x x x = = = = = = = = 26. Total Tourism Promotion Area Lodging Charges (Add charges due, lines 18-25) Reminder: Attach this addendum to your original return and mail to the Department. For tax assistance or to request this document in an alternate format, visit dor.wa.gov or call 360-705-6705. Teletype (TTY) users may use the Washington Relay Service by calling 711. Internet/Fax Add all Addendum totals and transfer the amount to the Total All Addendums line on your tax return. Period Year