Fillable Form Urt-1 - Indiana Utility Receipts Tax Return

Line 28. Refund. Enter the portion of line 27 that you

Paid Preparer Information

want refunded.

Fill out this area if a paid preparer completed this tax return.

Line 29. Overpayment credit. Enter the amount on

Note: This area needs to be completed even if the paid

line 27 that is to be applied to the following taxable

preparer is the same individual designated as your

year. Note: The total of lines 28 and 29 cannot exceed

personal representative.

the amount on line 27.

The paid preparer must provide the following

Certification of Signatures and

information:

• The name and address of the firm she

Authorization Section

represents;

Be sure to sign, date, and print your name on the re-

• Her identification number (check one box for

turn. If a paid preparer completes your return, you can

federal ID number, PTIN, or Social Security

authorize the Department to discuss your tax return

number);

with the preparer by checking the authorization box

• Her telephone number;

above the signature line. An officer of the organization

• Her complete address; and

must show her title and sign and date the tax return.

• Her signature with date.

Please enter your daytime telephone number so we can

call you if we have any questions about your tax return.

Make sure you keep a copy of your completed return.

Also, enter your e-mail address if you would like us to

be able to contact you by e-mail.

If you owe tax, please mail your return to:

Indiana Department of Revenue

Personal Representative Information

P.O. Box 7205

Typically, the Department will contact you if there are

Indianapolis, IN 46207-7205

any questions or concerns about your tax return. If

you want the Department to be able to discuss your

If you do not owe tax, please mail your return to:

tax return with someone else (e.g., the person who

Indiana Department of Revenue

prepared it or a designated person), you must com-

P.O. Box 7231

plete this area. First, you must check the “Yes” box that

Indianapolis, IN 46207-7231

follows the sentence “I authorize the Department to

discuss my tax return with my personal representative. ”

If you need further assistance, contact the Indiana

Department of Revenue, Tax Administration, 100

Next, enter the following:

N. Senate Ave., Indianapolis, IN 46204-2253, or call

• The name of the individual you are designating

(317) 232-0129. For other Indiana Department of

as your personal representative;

Revenue Forms, visit our website at

• The individual’s telephone number; and

Our homepage provides access to forms, information

• The individual’s complete address.

bulletins and directives, tax publications, e-mail, and

various filing options.

If you complete this area, you are authorizing the

Department to be in contact with your personal

Tax Forms Order Line - (317) 615-2581

representative other than you concerning information

about this tax return. After your return is filed, the

Department will communicate primarily with your

designated personal representative.

Note: You can decide at any time to revoke the autho-

rization for the Department to be in contact with your

personal representative. To do so, you will need to

tell us that in a signed statement. Include your name,

your Social Security number, and the year of your tax

return. Mail your statement to: Indiana Department of

Revenue, P.O. Box 40, Indianapolis, IN 46206-0040.

Form Urt-1 - Indiana Utility Receipts Tax Return - 2011 Page 7

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