Form Idr-909 - Qualified Solid Waste Energy Facility Payment Form
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Illinois Department of Revenue
IDR-909
Qualified Solid Waste
REV 1
E S ___/___/___
Energy Facility Payment Form
NS DP CA
Do not write above this line.
Station 033
Read this information first
– You must file one Form IDR-909, Qualified Solid Waste Energy Facility Payment Form, for each facility each month.
– Form IDR-909 is due on or before the 15th day of the month following the month you are reporting (Example: If you file Form IDR-909 for
April, it is due on or before May 15). Note: If a due date falls on a weekend or holiday, Form IDR-909 is due on the next working day.
– Fill out Step 3 only if the utility has paid you for the electricity you sold them. If you have not received payment from the electric utility, write
"no payment received" in Step 3 and write "0" on Line 11 in Step 4.
Step 1: Identify your business and write the period for which you are filing
1
6
Account ID:__ __ __ __ __ __ __ __
Liability period: ___ ___/___ ___ ___ ___
Calendar month and year
2
7
License no.: QW - ___ ___ ___ ___ ___
Authorized agent or contact person for the owning entity:
3
Facility name: _ _________________________________________
____________________________________________
___
4
8
Owning entity: _________________________________________
Authorized agent or contact person's daytime telephone number:
5
Address: _____________________________________________
(______)_______ - _______________
Number and street
Include area code
_____________________________________________________
City State ZIP
Step 2: Identify the utility to which you sold electricity
(generated using landfill methane )
9
10
Utility name: ___________________________________________
Account ID of utility: __ __ __ __ __ __ __ __
Step 3: Complete the columns below
(for the dates and kilowatt hours of electricity sales for which you have been paid)
Column A
Column B
Service month and year
Kilowatt hours
___ ___/___ ___ ___ ___
____________________
___ ___/___ ___ ___ ___
____________________
___ ___/___ ___ ___ ___
____________________
___ ___/___ ___ ___ ___
____________________
___ ___/___ ___ ___ ___
____________________
___ ___/___ ___ ___ ___
____________________
Total ____________________
Step 4: Figure the payment due
11
11
Total kilowatt hours of electricity from Step 3, Column B.
__________________________
.
12
$.0006
12
Multiply Line 11 by
(six-tenths of a mill). This is the amount of payment due.
$__________________
______
Make your check payable to "Illinois Department of Revenue."
Step 5: Sign below
Under penalties of perjury, I state that I have examined this form and, to the best of my knowledge, it is true, correct, and complete. We
understand that payments made into the Municipal Economic Development Fund do not relieve our facility of its obligation to reimburse the
Public Utility Fund and the General Revenue Fund for the actual reduction in payments to those funds as a result of credits received by elec-
tric utilities.
_____________________________
________________
(____)____-___________
____/____/________
Title:
Taxpayer’s signature and title (state if individual owner, member of firm, or corporate officer title) Telephone number (include area code) Date
_____________________________
________________
(____)____-___________
____/____/________
Firm:
Preparer's signature and name of the firm or employer (if applicable) Telephone number (include area code) Date
Step 6: Mail your completed Form IDR-909 and payment
*040701110*
ILLINOIS DEPARTMENT OF REVENUE
PO BOX 19019
SPRINGFIELD IL 62794-9019
IDR-909 R-04/10
This form is authorized by the Public Utilities Act. Disclosure of this information is Required. Failure to provide information could
result in this form not being processed. This form has been approved by the Forms Management Center. IL-492-4141
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