Form Urt-1 - Indiana Utility Receipts Tax Return

Indiana Department of Revenue

Form URT-1

2005 Indiana Utility Receipts Tax Return

(Do Not Write Above)

State Form 51102

For Calendar Year Ending December 31, 2005 or Other Tax Year

Federal Identification Number

(R1/8-05)

Beginning ____________/_______/2005 and Ending ____________/_______/_______

Principal Business Activity Code

Name

Street Address

County

Indiana Taxpayer Identification Number

City

State

Zip Code

Telephone Number

K Check accounting method used:

Cash

Accrual

Check box if an extension of time to file is attached:

M Check all boxes that apply to entity:

Initial Return

Final Return

Consolidated Return

In Bankruptcy

Taxable Receipts for Indiana

(List utility receipts received during your taxable year)

1. Retail sale of utility services .................................................................................................................................

2. Judgments or settlements as compensation for lost retail sales .........................................................................

3. Sales to a reseller if utility is used in hotels, mobile home parks or marinas ......................................................

4. Sales of water or gas to another for rebottling ...................................................................................................

5. Installation, maintenance, repair, equipment or leasing services provided and charges for removal ...............

6. All other receipts not segregated between retail and nonretail transactions .....................................................

7. Total Taxable Receipts (add lines 1 through 6) ...............................................................................................

Deductions

8. Annual taxpayer deduction ($83.33 per month, not to exceed $1,000 in a taxable year) .................................

9. Bad debts on utility receipts of an accrual basis taxpayer .................................................................................

10. Depreciation on resource recovery systems prorated for amount attributed to taxable year ...........................

10.

11. Receipts exempt from taxation if included in taxable receipts for the Mobile Telecommunications Sourcing

Act or IC 6-8.1-15. ................................................................................................................................................

11.

12. Amount paid on customarily returned empty reusable containers ......................................................................

12.

13. Receipts from sale of bottled water or gas that was previously taxed .............................................................

13.

14. Total Deductions (add lines 8 through 13) .......................................................................................................

14.

15. Indiana Taxable Utility Receipts (subtract line 14 from line 7) ......................................................................

15.

Tax and Credits

16. Utility Receipts Tax Due for the taxable year: Multiply the amount on line 15 by 1.4% (.014) ...................

16.

17. Sales/Use Tax Due on purchases subject to use tax (from worksheet) .........................................................

17.

18. Estimated payments made for utility receipts tax (list quarterly URT-Q payments below)

Qtr. 1___________

Qtr. 2___________

Qtr. 3___________

Qtr. 4___________ Enter Total ..

18.

19. Prior year overpayment credit ..............................................................................................................................

20. This year's extension payment .............................................................................................................................

20.

21. Total Payments (add lines 18 through 20) ........................................................................................................

21.

22. Net Tax Due (subtract line 21 from the sum of lines 16 and 17; if line 21 is greater proceed to line 23 and 27)

22.

23. Penalty for underpayment of estimated tax (from completed Schedule URT-2220) ...........................................

23.

24. Interest: If payment is made after the original due date, add interest (contact the Department for the current

interest rate) ..........................................................................................................................................................

24.

25. Penalty for late payment: If payment is made after the original due date, compute penalty of 10% of line 22 or

or $5, whichever is greater ..................................................................................................................................

25.

26. Total Amount Owed (Add lines 22 through 25) ...............................................................................................

26.

27. Overpayment (line 21 minus lines 16, 17 and 23) ....................................

27.

28. Refund (portion of amount on line 27 to be refunded) ..............................

28.

29. Overpayment Credit (carryover to the following year's estimated URT account, line 27 minus line 28) ......

29.

Under penalties of perjury, I declare I have examined this return, including accompanying schedules and statements, and to the best of my

knowledge and belief, it is true, correct, and complete. I authorize the Department to discuss my return with my tax preparer.Yes

Signature of Officer