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Add Penalty if Applicable Minimum 5. 00 Phone Number Date from page 2 line 19 25. Subtotal subtract line 24 from line 23 Internet/Fax IV. 00275 Insurance Agents Insurance Brokers Commission 14. 00484 Royalties Child Care 80 Wholesaling 03 Service Other Activities 04 Deductions taken but not itemized on page 3 will be disallowed. 5 Penalty Assessed After May 22 2006 20. Subtotal add lines 20-22 Make check or money order payable to the Washington State Department of Revenue. State and Local Use...

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