Tire Fee Return Form - Sample
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1TIRE FEE RETURN
PERIOD
1
NUMBER OF TIRES SUBJECT TO TIRE RECYCLING FEE
2
DUE DATE
+
PM
RATE PER TIRE
$ 0. 80
3
FEE DUE
ACCOUNT NO.
4
+
IF LATE
PENALTY 10% OF FEE DUE
5
INTEREST 1.08% PER MONTH OF FEE DUE
+
ADD
6
-
IF TIMELY -
DISCOUNT (MULTIPLY FEE DUE BY .006)
7
(
)
PRIOR BALANCE AMOUNT DUE (+) OR CREDIT (-)
8
TOTAL DUE (COMBINE LINES 2 THROUGH 7)
COMPTROLLER OF MARYLAND
REVENUE ADMINISTRATION DIVISION
ANNAPOLIS, MARYLAND 21411-0001
I declare under the penalties of perjury that this report has been examined by me and to the best of my knowledge and belief is a true and complete return.
SIGNATURE
TITLE
DATE
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