Fillable Form Urt-1 - 2012 Indiana Utility Receipts Tax Return

Line 24. Interest. If you make payment after the origi-

Next, enter the following:

• The name of the individual you are designating

nal due date, you must pay interest on the late pay-

ment. To view a chart of the current interest rates, see

as your personal representative;

Departmental Notice #3 at

• The individual’s telephone number; and

The rate is updated on or before November 1 to take

• The individual’s complete address.

effect on January 1 for the coming year.

If you complete this area, you are authorizing the

Line 25. Penalty for late payment. If you make your

Department to be in contact with your personal

payment after the original due date, you must pay a

representative other than you concerning information

penalty of 10 percent of the net tax due (line 22) or $5,

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

whichever is greater.

Department will communicate primarily with your

designated personal representative.

Line 26. Total amount owed. Add lines 22 through 25.

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

Line 27. Overpayment. If line 20 is greater than the

rization for the Department to be in contact with your

sum of lines 16, 17, and 23, enter the difference.

personal representative. To do so, you will need to

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

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

your Social Security number, and the year of your tax

want refunded.

return. Mail your statement to: Indiana Department of

Revenue, P.O. Box 7206, Indianapolis, IN 46207-7206.

Line 29. Overpayment credit. Enter the amount on

line 27 that is to be applied to the following taxable

Paid Preparer Information

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

Fill out this area if a paid preparer completed this tax

the amount on line 27.

return.

Certification of Signatures and

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

preparer is the same individual designated as your

Authorization Section

personal representative.

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

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

The paid preparer must provide the following

authorize the Department to discuss your tax return

information:

with the preparer by checking the authorization box

• The name and address of the firm she

above the signature line. An officer of the organization

represents;

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

• Her identification number (PTIN);

Please enter your daytime telephone number so we

• Her telephone number;

can call you if we have any questions about your tax

• Her complete address; and

return. Also, enter your email address if you would

• Her signature with date.

like us to be able to contact you by email.

Be sure you keep a copy of your completed return.

Personal Representative Information

Typically, the Department will contact you if there are

Please mail your return to (regardless of whether you

any questions or concerns about your tax return. If

owe tax):

you want the Department to be able to discuss your

Indiana Department of Revenue

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

P.O. Box 7228

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

Indianapolis, IN 46207-7228

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

follows the sentence “I authorize the Department to

discuss my tax return with my personal representative. ”

Form Urt-1 - 2012 Indiana Utility Receipts Tax Return - 2012 Page 7

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