Form Wp-1 - Water Protection And Clean Drinking Water Fee Return For Public Water Suppliers
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1KANSAS DEPARTMENT OF REVENUE
Division of Taxation
WATER PROTECTION & CLEAN DRINKING WATER FEE RETURN FOR PUBLIC WATER SUPPLIERS
Registration Number
Registration Num
Regi
Regi
stration Number
stration Number
ber
RETURN FOR
MUST BE FILED AND FEE(S) PAID BY
_______________________________________________
_______________________
IF NO SALES WERE MADE -- WRITE "NO SALES", SIGN AND RETURN FORM.
1. Number of Gallons Sold at Retail. . . . . . . . . . . . . . .
2. Divide Line 1 by 1,000 . . . . . . . . . . . . . . . . . . . . . . .
3. Water Protection Fee Due
(_______ times the amount on line 2) . . . . . . . . . . .
4. Clean Drinking Water Fee Due
(_______ times the amount on line 2) . . . . . . . . . . .
5. Total Amount Due (Add lines 3 & 4) . . . . . . . . . . . .
I CERTIFY THAT THIS IS A TRUE, CORRECT AND COMPLETE RETURN.
X
SIGNATURE
SIGNATURE
SIG
SIG
NATURE
NATURE
TITLE
TITLE
TITLE
TITLE
PHONE NUMBER
PHONE NUM
PHONE NUMBER
PHONE NUMBER
BER
WP-1 (Rev. 6/13)
COMPUTATION OF WATER PROTECTION FEE & CLEAN DRINKING WATER FEE
LINE 1:
Number of Gallons sold at Retail. Enter on LINE 1 the total gallons sold at retail for the reporting period.
LINE 2:
Divide LINE 1 by 1,000. Divide the number of gallons sold at retail by 1,000, rounding to the nearest whole number and enter
the result.
LINE 3:
Water Protection Fee Due. Multiply LINE 2 by the Water Protection Fee rate and enter the result.
LINE 4:
Clean Drinking Water Fee Due. Multiply LINE 2 by the Clean Drinking Water Fee rate and enter the result.
If you have opted-out of the Clean Drinking Water Fee, DO NOT complete LINE 4.
LINE 5:
Total Amount Due. Total the amounts from LINES 3 and 4, enter the result.
Sign the completed return and mail it with your remittance on or before the due date. Make remittance for the correct amount due in the form
of a check, draft or money order payable to the KANSAS WATER PROTECTION FEE.
For additional information, address your inquiries to: Kansas Department of Revenue, Miscellaneous Tax, 915 SW Harrison St., Topeka, KS
66612-1588, or call 785-368-8222.
Penalty and Interest, as provided by law, will be assessed and billed on the late payment of Water Protection Fee and/or Clean Drinking
Water Fee. For information on penalty and interest rates see our web site:
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