Form Kwh 4 - Self-Assessing Purchaser Tax Return printable pdf download

Form Kwh 4 - Self-Assessing Purchaser Tax Return

KWH 4

Rev. 12/10

P.O. Box 530

Columbus, OH 43216-0530

Self-Assessing Purchaser Tax Return

Account number

Period

Name

Address

Street address

City

State

ZIP code

Column B

Column C

Column A

1. Number of KWHs ﬁ led for current registration year

2. Number of taxable KWHs received this ﬁ ling period

3. Total taxable KWH for registration year (line 1 plus line 2)

4. If line 3 is greater than 500 million, subtract 500 million from total

taxable KWH (line 3 minus 500 million)

5. Line 2 minus line 4

6. Line 5 multiplied by $0.00257

.00

7. Line 4 multiplied by $0.001832

.00

8. Tax due (line 6 plus line 7)

.00

9. Interest (see instructions)

.00

10. Total amount due (line 8 plus line 9)

.00

By the 20th day of each month, the return shall be ﬁ led with the Ohio Department of Taxation along with payment of the total

amount due. If ﬁ ling a paper return, make check payable to Ohio Treasurer of State and write the account number on your

check. Failure to timely ﬁ le and pay the tax may result in an additional charge of $50 or 10% of the tax, whichever is greater.

I declare under penalties of perjury that this return, including any accompanying schedules and statements, has been examined

by me and to the best of my knowledge and belief is a true, correct and complete return and report.

Signature

Title

Telephone

Date

Form Kwh 4 - Self-Assessing Purchaser Tax Return