Quarterly Solid Waste Disposal Fee Report Form - Alabama Department Of Revenue printable pdf download

TOB: SWST

10/08

DEPARTMENT USE ONLY

LABAMA

EPARTMENT OF

EVENUE

Certificate Date: _________________

, U

& B

ALES

USINESS

IVISION

Certificate No.: __________________

OBACCO

ECTION

Amount Paid: _____________________

P.O. B

327556 • M

, AL 36132-7556

ONTGOMERY

Checked By: ____________________

Phone (334) 242-9627 • Fax (334) 353-1011

Quarterly Solid Waste Disposal Fee Report

Required by Act No. 2008-151

For the Quarter Ending (March, June, September, December (Circle Appropriate Month)), 20_____

COMPANY

PERMIT NO. (Issued by the Alabama Department of Environmental Management)

FEIN / SSN

ADDRESS

CONTACT PERSON

CITY

STATE

ZIP

TELEPHONE NUMBER

E-MAIL ADDRESS

FEE COLLECTED

INDICATE TOTAL

QUARTERLY TONS

(Multiply tons and/or yards in

SOLID WASTE

OR CUBIC YARDS

FEE RATE

Column B by fee rate in Column C)

1. Waste received for disposal in a municipal solid waste landfill. Regulated solid waste

that may be approved by ADEM as alternate cover materials in landfills. Regulated solid

waste received from out-of-state for disposal at permitted public solid waste facilities.

1 00

1. Tons. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2. Waste received for disposal in public industrial landfills, construction and demolition

landfills, non-municipal solid waste incinerators, or composting facilities, which was not

generated by the permittee. Regulated solid waste that may be approved by ADEM as

alternate cover materials in landfills. Regulated solid waste received from out-of-state for

disposal at permitted public solid waste facilities.

1 00

2a. Tons (show tons if scales available) . . . .

2b. Cubic Yards . . . . . . . . . . . . . . . . . . . . . .

3. Waste generated for disposal in a private solid waste management facility. (Complete

schedule below. Do not exceed payment of $1000 per calendar year.)

3. Total Cubic Yards . . . . . . . . . . . . . . . . . . .

4. TOTAL FEE DUE (Add fees in Column D, Lines 1, 2a, 2b and 3) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

5. 4% Allowance (Multiply Column D, Line 4 by 4% and enter results here).

Private Facilities identified on Line 3 cannot take this allowance. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6. FEE DUE (Subtract Column D, Line 5 from Line 4, and enter results here) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

7. Failure to Timely File Penalty (The greater of 10% of Column D, Line 6 or $50) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

8. Failure to Timely Pay Penalty (10% of Column D, Line 6) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

9. Interest (Contact the Department for rate) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

10. TOTAL AMOUNT DUE (Add Column D, Lines 6 through 9) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

If payment is made by Electronic Funds Transfer (EFT) check this box . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Schedule to be Completed by Private Solid Waste Facilities ONLY

a. Total cubic yards this quarter (Enter here and in Column B, Line 3 above.). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

b. Basic fee @ $0.25 per cubic yard (Multiply cubic yards on Line “a” by $0.25.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

c. Previous fee(s) paid this year (Add amount paid on Line “e” from previous quarter report(s) for this year) . . . . . . . . . . . . .

d. Maximum remaining fee (Subtract amount on Line “c” from $1000). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

e. Amount now due (Enter the smaller of Lines “b” or “d” here and in Column D, Line 3 above. If zero or less, enter -0-) . . .

Under penalties of perjury, I hereby certify that the return made by me is true and correct.

Signature _________________________________________________________ Title ______________________________________ Date ___________________________