Form Idr-909 - Illinois Qualified Solid Waste Energy Facility Payment Form printable pdf download

Illinois Department of Revenue

IDR-909

Qualified Solid Waste

Energy Facility Payment Form

Station 033

Read this information first

You must file one form for each facility each month. The form is due on or before the 15th day of the month following the month you are

reporting. (For example, a form filed for April is due on or before May 15.) If the due date falls on a weekend or holiday, then the form 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 8 in Step 4.

Step 1: Identify your business and write the period for which you are filing

Facility name: _________________________________________

Name of the authorized agent or contact person for the owning entity:

Owning entity: _________________________________________

__________________________________________________

___

Address: _____________________________________________

Authorized agent or contact person's daytime telephone number:

_____________________________________________________

(______)_________________

City

State

ZIP

Filing period: __________________________________________

Calendar month and year

Step 2: Identify the utility to which you sold electricity

(generated using landfill methane )

Utility name: __________________________________________

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

Write the total kilowatt hours of electricity from Step 3, Column B.

__________________________

$.0006

Multiply Line 8 by

(six-tenths of a mill). This amount is the 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

electric utilities.

_____________________________________________________________________________(____)_______________

_ _/_ _ /_ _ _ _

Authorized representative's signature

Title

Phone

Date

_____________________________________________________________________________(____)_______________

_ _/_ _ /_ _ _ _

Paid preparer's signature

Name of firm or employer, if any

Phone

Date

Mail your completed form and payment to:

ILLINOIS DEPARTMENT OF REVENUE

PO BOX 19019

SPRINGFIELD IL 62794-9019

This form is authorized by the Public Utilities Act. Disclosure of this information is Required. Failure to provide information could

IDR-909 N-10/00

result in this form not being processed. This form has been approved by the Forms Management Center.

IL-492-4141

Form Idr-909 - Illinois Qualified Solid Waste Energy Facility Payment Form

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