Form Epcq Environmental Protection Charge Quarterly Return

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This form is for Iowa Tax Amnesty use only.
Iowa Tax Amnesty forms cannot be
filed electronically. Mail the Tax Amnesty
Application form and attachments to:
Iowa Tax Amnesty
P.O. Box 1792
Des Moines, IA 50306
IOWA DEPARTMENT OF REVENUE
If you had nothing to report this quarter,
EPCQ
put zeroes on lines 1 and 7.
ENVIRONMENTAL PROTECTION CHARGE
QUARTERLY RETURN
87-002 8/16/07
1 TOTAL GALLONS
Date Due
Permit No.
For Quarter Ending
2 EXEMPT GALLONS AND GALLONS
QUALIFYING FOR CREDIT
3 GALLONS SUBJECT TO CHARGE
$
4 CHARGE DUE
I declare that this return is correct and complete.
$
0
5 PENALTY does not apply for Iowa Tax Amnesty
$
Date
Title
6 INTEREST
Signature
Daytime Phone No.: ________________
$
Check box if this is your final return and give the last date of
7 TOTAL AMOUNT DUE
gallons subject to EPC charge: _______________________ .
You must itemize on line 8, 9, and 10 the total gallons entered
8 EXEMPT GALLONS
8
on line 2 of this form. Failure to itemize will result in disallowance
of all gallons shown on line 2 of this form.
9 GALLONS QUALIFYING FOR CREDIT
9
10 TOTAL (add lines 8 and 9, enter on line 2)
10
INSTRUCTIONS
1. TOTAL GALLONS: Enter the total petroleum gallonage placed into
7. TOTAL AMOUNT DUE: Add the amounts on line 4, 5, and 6. Make
all storage tanks for the entire quarter.
check payable to Treasurer, State of Iowa.
2. EXEMPT GALLONS AND GALLONS QUALIFYING FOR CREDIT:
8. EXEMPT GALLONS: Enter the petroleum gallonage pumped into
Enter the total gallons from line 10.
exempt storage tanks for the entire quarter. These amounts must
be included in line 1.
3. GALLONS SUBJECT TO CHARGE. Subtract line 2 from line 1.
9. GALLONS QUALIFYING FOR CREDIT: Enter the petroleum
4. CHARGE DUE: The charge rate is 1 cent per gallon. Multiply the
gallonage for the quarter which qualifies for credit under Iowa Code
gallonage on line 3 by $.01.
Section 424.6(1).
5. PENALTY does not apply for Iowa Tax Amnesty.
10. TOTAL OF EXEMPT GALLONS AND GALLONS QUALIFYING FOR
6. INTEREST: Interest accrues on the unpaid portion of charge from
CREDIT. Add lines 8 and 9, and enter the total here and on line 2
the due date on the return. Any fraction of a month is considered a
of this form.
whole month for purposes of computing interest. Check our Web
site for interest rates at:

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