Fillable Form 5507 - Public Utility Tax Claim For Refund

Form 5507 - Public Utility Tax Claim For Refund - 2013

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Form 5507

2013

PUBLIC UTILITY TAX

CLAIM FOR REFUND

FOR OFFICE USE ONLY

Rev. Code 054

This return is for calendar year 2012. If not for calendar year, insert ending date of fiscal year

Name of Business

Address

Zip Code

Delaware address if different from above

Zip Code

Date and State of Incorporation

Employer Identification Number

Nature of Business

BUSINESS ACTIVITIES

Check the appropriate qualifying activity(s):

Scientific, Agricultural or Industrial Research

Aviation Maintenance & Repair Services

Computer Software Sale (Wholesale Only)

Telecommunications

Consumer Credit Reporting/Collection Services

Wholesaling

Management & Support Services for Activities Listed

Data Processing or Data Preparation

Combination of Activities listed

Engineering

Manufacturing

PART 1 SECTION 5507(a) - QUALIFYING NEW BUSINESS FACILITY

New Business Facility

Date Placed in Service

Address of Facility

Enter the total public utility tax paid (Gas & Electric only) during the taxable year at the new facility

Subtract the amount of the refund from Part 1

–

Difference

Multiply by 50%

.50

Refund

PART 2 SECTION 5570(b) - QUALIFYING EXPANDED FACILITY

Expanded Facility

Date Placed in Service

Address of Facility

Enter the total public utility tax paid (Gas & Electric only) during the taxable year at the expanded facility

–

Subtract the amount of the refund from Part 1

Subtract the total public utility tax paid at the expanded facility during the first preceding taxable year in which

–

the expanded facility was placed in service.

Difference

.50

Multiply by 50%

Refund

PART 3 TOTAL REFUND

Add Amount of Refunds from Parts 1 and 2 and enter here

Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and

belief it is true, correct and complete. If prepared by a person other than the taxpayer, his declaration is based on all information of which he has any knowledge.

Date

Signature of Officer

Title

Date

Signature of individual or firm preparing the return

Address

MAIL TO: DIVISION OF REVENUE, P.O. BOX 2044, WILMINGTON, DELAWARE 19899-2044

*DF42513019999*

(Revised 0 1/28/13)