Form 28 - Nebraska Litter Fee Return
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1
2FORM
Nebraska Litter Fee Return
28
PLEASE DO NOT WRITE IN THIS SPACE
Nebraska ID Number
Due Date
Period Covered by Return
RESET
PRINT
NAME AND LOCATION ADDRESS
NAME AND MAILING ADDRESS
Check this box if you have discontinued your business.
If you have more than one business location making sales in this state, refer to the paragraph
titled “Persons With More Than One Location” in the instructions on the reverse side.
1 Gross proceeds from the manufacture and sale, and sale at wholesale in this state of products and
$
00
by-products subject to the litter fee .....................................................................................................................
1
00
2 Gross proceeds from the retail sale of products and by-products in this state subject to the litter fee ................
2
3 Enter the greater of line 1 or line 2, unless the amount to be entered on line 3 is less than
00
$100,000. If the amount is less than $100,000, enter zero (-0-). ..........................................................................
3
4 Nebraska litter fee (line 3 multiplied by
) ......................................................................................
4
5 Previous balance with applicable interest at
% per year and payments received through
5
Check this box if your payment is being made electronically.
$
6 BALANCE DUE (line 4 plus line 5). Pay in full with return ....................................................................................
6
Under penalties of law, I declare that I have examined this return, and to the best of my knowledge and belief, it is correct and complete.
sign
(
)
here
Authorized Signature
Daytime Phone
Signature of Preparer Other Than License Holder
Title
Date
Address
Date
Email Address
Instructions
Who Must File. Every person who has annual gross proceeds
Out-of-state manufacturers, wholesalers, and retailers report only
the gross proceeds from Nebraska sales of items specified in the
from sales in Nebraska of products subject to the litter fee from all
line 1 and line 2 instructions on this return. The Nebraska Litter
locations of at least $100,000 must obtain a litter fee license. A litter
fee license can be obtained by filing a Nebraska Tax Application,
Fee Information Guide can be found on the Department’s website
Form 20. A separate application for a litter fee license is required
at
for each place of business in Nebraska.
When and Where to File. This return, properly signed and
The Nebraska litter fee and the Nebraska waste reduction and
accompanied by a check or money order payable to the Nebraska
recycling fee are separate programs. It is possible that your
Department of Revenue, will be considered timely filed if
company is required to pay both fees.
postmarked on or before the due date stated on the face of the return.
Mail this return and payment to: Nebraska Department of Revenue, PO Box 94818, Lincoln, NE 68509-4818
, 800-742-7474 (NE and IA), 402-471-5729
5-215-1996 Rev. 7-2013
5-215-1996 Rev. 7-2013
5-215-1996 Rev. 7-2013
5-215-1996 Rev. 7-2013
5-215-1996 Rev. 7-2013
Please make a copy of this return for your records.
Supersedes 5-215-1996 Rev. 8-2011
Supersedes 5-215-1996 Rev. 8-2011
Supersedes 5-215-1996 Rev. 8-2011
Supersedes 5-215-1996 Rev. 8-2011
Supersedes 5-215-1996 Rev. 8-2011
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