Indiana Department of Revenue
State Form 46244
Hazardous Waste Disposal Tax Return
(R3 / 10-11)
The Department of Revenue will not process any
application which does not contain a Federal
Identiﬁ cation Number or Social Security Number
and a signature of owner or ofﬁ cer of the company.
Quarter Ending __________________, 20________
Due The 20th Day After The End Of The Quarter
Federal I.D. Number:
Disposal Facility Name:
County of Disposal Facility:
Section I: Disposal by Underground Injection - Maximum Annual Tax Limits $25,000.00
Enter the total tons of hazardous waste disposed by underground injection during the calendar
quarter (attached Schedule HW-021).
Tax Due (multiply Line 1 by the current tax rate - see instructions).
Enter the total of all previous hazardous waste tax paid on underground injection for the current
Total hazardous waste tax for the calendar year (Line 2 plus Line 3).
If Line 3 is greater than or equal to $25,000.00, enter zero (-0-) on Line 5.
Read Instructions before
If Line 4 is greater than or equal to $25,000.00, but Line 3 is zero (-0-), enter $25,000.00 on
entering an amount on
C. If Line 4 is less than $25,000.00, enter the ﬁ gure from Line 2 on Line 5.
D. If Line 2 is less than $25,000.00, but Line 4 is greater than $25,000.00, enter the difference of
$25,000.00 minus Line 3 on Line 5.
Net tax due on underground injection for the current calendar quarter.
Section II: Disposal by Other Methods - Hazardous Waste Generated in Indiana
Enter the total tons of hazardous waste generated in and disposed of in Indiana (attach Schedule
Tax Due (multiply Line 6 by the current tax rate - see instructions).
Section III: Disposal by Other Methods - Hazardous Waste Generated Outside of Indiana
Enter the total tons of hazardous waste generated outside of Indiana and subsequently disposed of
in Indiana (attach Schedule HW-021).
Tax due (multiply Line 8 by the out of state tax rate of the state in which the hazardous waste was
generated or the current Indiana tax rate, Whichever is Greater - see instructions).
Section IV: Amount Due
10. Total tax due (enter the total of Line 5, 7 and 9).
11. Penalty (10% of Line 10, if ﬁ led after the due date).
12. Interest (if ﬁ led after the due date, see instructions).
13. Total amount due (enter the total of Line 10, 11 and 12).
I hereby declare under the penalty of perjury that the information contained in this return, including accompanying
schedules and statements, is true, correct and complete to the best of my knowledge and belief.
Signature of Taxpayer or Duly Authorized Agent
Print or Type Name Title
Make Check Payable to: Indiana Department of Revenue and mail the completed return and check to:
Indiana Department of Revenue, Special Tax: Environmental, P.O. Box 6080
Indianapolis, Indiana 46206-6080