Form E -500k - Solid Waste Disposal Tax Return

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Solid Waste Disposal Tax Return
North Carolina Department of Revenue
Period Beginning (MM-DD-YY)
Period Ending (MM-DD-YY)
Account ID
Number of Tons
Rate
Tax
,
.
.
,
1. Municipal Solid Waste and
x
$2
=
Construction and Demolition Debris
Legal Name (First 24 Characters)
(USE CAPITAL LETTERS)
.
,
2. Penalty
Street Address
,
.
3. Interest
City
State
Zip Code (5 Digit)
,
.
$
4. Total Due
(Add Lines 1, 2, and 3)
Signature:
Date:
I certify that, to the best of my knowledge, this return is accurate and complete.
(
)
Title:
Phone:
E-500K
MAIL TO: P.O. Box 25000, Raleigh, NC 27640-0710
10-08

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