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

Form Kwh-4 - Prescribed Tax Form Kwh-4 - Self-Assessing Purchaser Tax Return

Prescribed Tax Form

KWH-4 (06/01)

SELF-ASSESSING PURCHASER TAX RETURN

(Instructions on Reverse Side)

Account Number: _______________________

Period: _________________________

Name: _____________________________________________________________________

Address: __________________________________________________________________

(Street)

(City)

(State)

(Zip)

COLUMN A

COLUMN B

COLUMN C

1.) Number of taxable KWHs received

2.) Line 1 multiplied by $0.00075

.00

3.) Price of all KWHs on Line 1

4.) Line 3 multiplied by 0.04

.00

5.) Tax Due

(Total of lines 2 + 4)

.00

6.) Interest

(see instructions)

.00

7.) Total Amount Due

( Total of lines 5 + 6)

.00

By the twentieth day of each month, each self-assessing purchaser shall file a return with the

Department of Taxation and shall make payment of the full amount of tax due. Make check payable to

Treasurer of State of Ohio. Failure to timely file and pay the tax may result in an additional charge up

to fifty dollars ($50.00) or 10% of the tax, whichever is greater.

_______________________

__________________

_____________

____________

Signature:

Title:

Phone:

Date:

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.

Internal Use Only

Excise and Motor Fuel Tax Division

Excise Tax Unit

P.O. Box 530, Columbus, Ohio 43216-0530

Phone: (614) 466-7026

Fax:

(614) 752-8644

E-Mail:

Form Kwh-4 - Prescribed Tax Form Kwh-4 - Self-Assessing Purchaser Tax Return

Related Articles

Related forms

Related Categories