Form 53-E25 - Annual 25 Percent Eedp - Reconciliation Return - 25 Percent Recovered Material

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MISSOURI TAX ACCOUNT NUMBER:

MISSOURI DEPARTMENT OF REVENUE

FORM

ADRE

TAXATION DIVISION

___ ___ ___ ___ ___ ___ ___ ___

P.O. BOX 840

53-E25

JEFFERSON CITY, MO 65105-0840

(573) 751-2836

• DO NOT WRITE IN SHADED AREAS

ANNUAL 25% EEDP

TDD (800) 735-2966

(REV. 11-2010)

RECONCILIATION RETURN —

25 PERCENT RECOVERED MATERIAL

OWNER’S NAME

REPORTING PERIOD

ADDRESS CORRECTION

MAILING ADDRESS

BUSINESS LOCATION

BUSINESS NAME

FEDERAL IDENTIFICATION NUMBER

__ __ __ __ __ __ __ __ __

BUSINESS PHONE NUMBER:

Check here if

phone #

MAILING ADDRESS

TELEPHONE NUMBER

(__ __ __) __ __ __ - __ __ __ __

changed

(__ __ __) __ __ __ - __ __ __ __

CITY

STATE

ZIP

January 31, 2011

DUE DATE:

__ __ __ __ __

IMPORTANT:

THIS RETURN MUST BE FILED FOR THE REPORTING PERIOD INDICATED EVEN THOUGH YOU HAVE NO GROSS RECEIPTS/TAX TO REPORT.

BUSINESS LOCATION

CODE

TAXABLE UTILITY PURCHASES

RATE (%)

AMOUNT OF TAX

FULL RATE

MANUFACTURING EXEMPTION (LOCAL TAX ONLY)

TOTALS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

SUBTRACT: 2% TIMELY PAYMENT

PART A — RECOVERED MATERIALS CONTENT

ALLOWANCE (if Applicable) . . . . . . . .

I hereby affirm that the raw materials used in processing per the location(s) referenced above contain at

–

least twenty-five percent (25%) recovered materials in each product as defined in Section 260.200 RSMo.

No significant product type or ingredient changes have occurred for the reporting period.

TOTAL SALES TAX DUE . . . . . . . . . .

Recovered Materials Qualifying Product % __________________

ADD: INTEREST FOR LATE

(If multiple product lines, attach percentage information for each.)

PAYMENT

25%–30% recovered material — obtain vendor declaration statements, fill out Part B,

ADD: ADDITIONS TO TAX . . . . . . . . .

Recovered Material Calculations

Check

30% or higher with last audit and 30% or higher for current period in recovered material

applicable

SUBTRACT: APPROVED CREDIT . . .

content

–

box:

In accordance with Section 144.030.2 (12) RSMo, rebuttable presumption that the raw

PAY THIS AMOUNT

materials used in the primary manufacture of automobiles contain at least twenty-five

(U.S. FUNDS ONLY) . . . . . . . . . . .

percent recovered materials.

This declaration statement must be signed and dated by an authorized official of the company.

Signature, Title and Date

PRODUCT OR PRODUCTS PRODUCED

PART B — CALCULATION OF RECOVERED MATERIAL CONTENT IN RAW MATERIALS

Complete Section B ONLY if you checked the first check box in Part A (25–30% recovered material)

List all raw material suppliers and percentage of recovered material content necessary to qualify for the exemption.

Description of

Total Weight

Weight or Volume of

% Recovered Materials in

% of Recovered

Name of Raw Material Supplier

Raw Material

or Volume (1)

Recovered Materials (3)

Total Raw Materials (4)

Material (2)

EXAMPLE

Attach a detailed listing

TOTAL

CHECK FIGURE (5)

(1) You can use either the weight of the materials or the volume of the materials. In either case, you must use the same unit of measure (pounds, ounces, feet or inches).

(2) This represents the percent of recovered materials in the raw materials. Obtain this information annually from your suppliers by having them complete Form 5021,

Manufacturers Declaration of Recovered Material Content. These forms should be maintained with your records.

(3) Multiply the amount in Column B by the percentage in Column C.

(4) Divide amounts in Column D by the total of Column B.

(5) Check Figure: Total of Column D divided by Column B (This number should equal the total for Column E.)

The calculation in Column B determines if you qualify for this exemption for the next calendar year. (If the second or third box in Part A is checked, you also qualify for this

exemption.) If you do not qualify, it is your responsibility to notify your utility provider, withdraw your exemption, and remit the appropriate tax to the Department of Revenue.

MO 860-3040 (11-2010)