Form Idr-909-X - Amended Qualified Solid Waste Energy Facility Payment Form
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1Illinois Department of Revenue
IDR-909-X
REV 2 Form 859
Amended Qualified Solid Waste
E S ___/___/___
Energy Facility Payment Form
NS DP CA
Do not write above this line.
Station 033
Read this information first
•
You must file Form IDR-909-X for each facility each month that you need to correct your original return or a previously filed amended
return. You must attach any supporting documentation.
•
Fill out Step 2 only if the utility has paid you for the electricity you sold them. If you have not received payment from the electric utility,
write "0" on Line 3 in Step 3.
•
Mail your Form IDR-909-X and payment to the Illinois Department of Revenue, PO Box 19019, Springfield, Illinois, 62794-9019.
Identify your business and write the period for which you are filing
Account ID:__ __ __ __ __ __ __ __
Liability period: ___ ___/___ ___ ___ ___
Calendar month and year
License no.: QW - ___ ___ ___ ___ ___
Authorized agent or contact person for the owning entity:
Facility name: __________________________________________
____________________________________________
___
Owning entity: _________________________________________
Authorized agent or contact person's daytime telephone number:
Address:
_____________________________________________
(______)_______ - _______________
Number and street
Include area code
______________________________________________________
City State ZIP
Step 1: Identify the utility to which you sold electricity
(generated using landfill methane )
1
2
Utility name: ___________________________________________
Account ID of utility: __ __ __ __ __ __ __ __
Step 2: Complete the columns below -
Figures as they should have been reported
(for the dates and kilowatt
hours of electricity sales for which you have been paid)
Column A - Service month & year
Column B - Kilowatt hours
___ ___/___ ___ ___ ___
____________________
___ ___/___ ___ ___ ___
____________________
___ ___/___ ___ ___ ___
____________________
___ ___/___ ___ ___ ___
____________________
___ ___/___ ___ ___ ___
____________________
___ ___/___ ___ ___ ___
____________________
Total: ____________________
Step 3: Figure the payment due -
Figures as they should have been reported
3
3
____________________
Total kilowatt hours of electricity from Step 3, Column B.
4
$.0006
4 $_______________.____
Multiply Line 3 by
(six-tenths of a mill). This is your net tax due.
5
Total amount you paid - including the amount you paid with your actual return, any subsequent
amended return(s), & tax (no penalty & interest) you paid on any assessment for this liability period.
5 $_______________.____
Reduce the total amount by any credit or tax refund (no interest) received for this liability period.
6
6 $_______________.____
If Line 5 is greater than Line 4, figure your overpayment by subtracting Line 4 from Line 5.
7
7 $_______________.____
If Line 5 is less than Line 4, figure your underpayment by subtracting Line 5 from Line 4.
Pay this amount and make your check payable to "Illinois Department of Revenue."
*285901110*
Step 4: Check the reason you are filing this amended form
❑
I made a computation error that resulted in an overpayment.
❑
I made a computation error that resulted in underpayment of tax.
❑
The original Account ID was incorrect. The incorrect Account ID is __ __ __ __ __ __ __ __.
❑
The original reporting period was incorrect. The incorrect reporting period is ___________________________.
❑
Other. Please explain.___________________________________________________________________________________________
Step 5: Sign below
Under penalties of perjury, I state that I have examined this form and, to the best of my knowledge, it is true, correct, and complete. We under-
stand that payments made into the Municipal Economic Development Fund do not relieve our facility of its obligation to reimburse the Public
Utility Fund and the General Revenue Fund for the actual reduction in payments to those funds as a result of credits received by electric utilities.
_____________________________
________________
(____)____-___________
____/____/________
Title:
Taxpayer’s signature and title (state if individual owner, member of firm, or corporate officer title) Telephone number (include area code) Date
_____________________________
________________
(____)____-___________
____/____/________
Firm:
Preparer's signature and name of the firm or employer (if applicable) Telephone number (include area code) Date
This form is authorized as outlined under Article VIII of the Public Utilities Act. Disclosure of this information is required. Failure to
IDR-909-X (R-10/12)
provide information may result in this form not being processed and may result in a penalty.
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