Form Dry-012 - Dry Cleaning Facility Fee Return
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DRY CLEANING
Wisconsin Department of Revenue
PO Box 8946
FACILITY FEE
Madison WI 53708-8946
RETURN
( DRY-012 )
Enter Tax Account # in field below
To enter dates, use the
and tab to navigate throughout form.
following format: MM DD YYYY
Tax Account Number
Period Begin Date
Period End Date
Due Date
030
Enter name and address. Hit "Enter" to start
each new line of the name and/or address.
Check if this is an AMENDED return
Check if address or name change
(Note changes at left)
Submit original returns only.
Do not submit photocopy.
Complete form using BLACK INK
NO COMMAS
1. Total sales from dry cleaning for this reporting period . . . . . . . . . . . . . 1
2. Dry cleaning facility fee (multiply line 1 by .028) . . . . . . . . . . . . . . . . . . 2
0.00
3. Interest and penalty (see instructions on back) . . . . . . . . . . . . . . . . . . 3
4. Total amount due (add lines 2 and 3) . . . . . . . . . . . . . . . . . . . . . . . . . . 4
0.00
This return must be filed by the due date, even if you have
Make check payable and mail to:
no fee to report. Failure to file this return on time will result
Wisconsin Department of Revenue
in late filing fees and may result in additional penalties.
PO Box 8946
Please see the instructions for additional information
Madison WI 53708-8946
regarding the computation of late fees and penalties.
I hereby certify that the amounts entered on this return are true and correct to the best of my knowledge and belief.
Contact Name (please print)
Date
Phone
(
)
Your signature
E-mail address
DRY-012 (R. 8-12)
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Parent category: Financial