EW1
E-Waste Annual Registration Fee 2014
Due September 2, 2014, based on the period July 1, 2013, through June 30, 2014.
Check if amended:
Business Name
FEIN
Address
Minnesota Tax ID Number
City
State
Zip Code
Read the instructions on the back before completing this form.
1 Base fee. If you produce 100 or more VDDs annually that are sold to Minnesota households,
enter $2,500. If you produce fewer than 100, enter $1,250 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
2 Pounds of VDDs sold to Minnesota households during the period (from line 4 of Schedule A) . . . . . . . . 2
3 VDD sales required to be recycled (multiply line 2 by 80% [0.80]) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
4 Pounds of recycled covered electronic devices (CED):
a from the 11-county metropolitan area (from line 3 of Schedule B1) . . . . . 4a
b from Greater Minnesota (from line 5 of Schedule B2) . . . . . . . . . . . . . . . . 4b
c carried over from last year (from line 4 of Schedule C) . . . . . . . . . . . . . . . . 4c
Add lines 4a, 4b and 4c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
5 Pounds not recycled:
a If line 4 is more than line 3, subtract line 3 from line 4 and enter the
result on line 5a and on Schedule C, line 6. This is the current year’s
carryover of pounds. Skip lines 5, 6, 7 and 8, and enter the amount
from line 1 on line 9 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5a
If line 3 is more than line 4, subtract line 4 from line 3
and enter the result here. Continue with line 6 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
.
6 Percentage recycled (divide line 4 by line 3) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
7 Using the decimal amount on line 6, determine your price per pound from the following:
If line 6 is:
enter on line 7:
less than 0.50
$0.50
at least 0.50, but less than 0.90
$0.40
at least 0.90, but less than 1.0
$0.30
1.0 or more
-0- . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
8 Recycling fee (multiply line 5 by line 7) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
9 Base fee and recycling fee due (add lines 1 and 8) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
10 Penalty (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
11 Interest (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
12 TOTAL AMOUNT DUE. Add lines 9, 10 and 11 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
electronic payment
check (made payable to Minnesota Revenue)
Check payment method:
I declare that this return and supporting schedules are correct and complete to the best of my knowledge and belief.
Authorized Signature
Title
Date
Daytime Phone
Mail return and required schedules to: Minnesota Revenue, Mail Station 3331, St. Paul, MN 55146-3331.
Email: environmental.tax@state.mn.us
Phone: 651-282-5770 (TTY: Call 771 for Minnesota Relay)