Fillable Form 5068 - Tire And Lead-Acid Battery Fee Return printable pdf download

MISSOURI DEPT. OF REVENUE

1C. Total

1A. Tires

1B.

Tires

P.O. BOX 3040

Sold

Adjust. + or –

2A.

JEFFERSON CITY, MO 65105-3040

2C. Total

2B.

Batteries

TIRE AND LEAD-ACID

Batteries

Adjust. + or –

Sold

BATTERY FEE RETURN

3. Total Tires and Batteries Sold

Line 1C plus Line 2C ........... =

MISSOURI I.D. NUMBER

5 0

4. Tire and Battery Fee Rate ...X

__ __ __ __ __ __ __ __

5. Tire and Battery Fee.

FILE PERIOD

DUE DATE(MM/DD/YYYY)

Line 3 times Line 4 (Rate) .... =

__ __ / __ __ / __ __ __ __

6. Collection Deduction.

Line 5 times 6% ................... –

BUSINESS NAME

7. Total Fees Due.

Line 5 minus Line 6 ............. =

STREET ADDRESS

8. Addition to Fees

(see instructions) ................ +

9. Interest for Late Payment

CITY, STATE, AND ZIP CODE

(see instructions) ................. +

10. Approved Credit

DOR-5068 (02-2013)

(see instructions) ................ –

IF FINAL RETURN

I have direct control, supervision, or responsibility

11. Pay This Amount (U.S. Funds)

ENTER CLOSE DATE.

for filing this return and payment of the fee due.

Total of Lines 7-9 minus Line 10 =

Under penalties of perjury, I declare that this is a true,

accurate, and complete return.

__ __ / __ __ / __ __ __ __

If you pay by check, you authorize the

Department of Revenue to process

DOR

AUTHORIZED SIGNATURE

DATE(MM/DD/YYYY)

USE

the check electronically.

Any check

ONLY

returned unpaid may be presented again

electronically.

__ __ / __ __ / __ __ __ __

INSTRUCTIONS FOR COMPLETING TIRE AND LEAD-ACID BATTERY FEE RETURN

NOTE: If Additions to Fees for failure to file applies, do not pay

If you have questions that are not covered in these instructions,

you may contact the Department of Revenue at the

additions to fees for failure to pay.

addresses, e-mail addresses, and phone numbers listed on the last

For example, if a return due April 30 is filed any time between May 1

page of these instructions. You may also refer to our web site at

and May 31, the rate would be five percent (5%); if filed between June

1 and June 30, the rate would be ten percent (10%); and so on, up to

LINE 1A: TIRES SOLD — Enter the total number of tires sold for

a maximum of twenty five percent (25%).

this report period. Enter zero “0” if you have nothing to report for this

Example: Return is due April 30, but is filed (postmarked) May 15.

reporting period.

Line 7 is $480

$480 X 5% = $24

LINE 1B: ADJUSTMENTS — Add or subtract total qualifying ad-

$24 is the Additions to Fees

justments. Indicate a plus (+) or minus (–) sign for the adjustments.

Enter zero “0” if you have nothing to report for this reporting period.

Example: Return is due April 30, but is filed (postmarked) June 1.

Line 7 is $480

LINE 1C: TOTAL TIRES — Enter the total of Box 1A (Tires Sold)

$480 X 10% = $48

plus (+) or minus (–) Box 1B (Adjustments). Enter zero “0” if you have

$48 is the Additions to Fees

nothing to report for this reporting period.

LINE 9: INTEREST FOR LATE PAYMENT — If fees are not paid by

LINES 2A, 2B, AND 2C: LEAD-ACID BATTERIES — Enter the ap-

the due date, multiply Line 7 by the daily interest rate. Then multiply

propriate Batteries Sold, Adjustments, and Total Batteries. Refer to

this amount by number of days late.

instructions for Line 1A, 1B, and 1C on method of calculation. Enter

zero “0” if you have nothing to report for this reporting period.

NOTE: Number of days late is counted from the due date to the post-

mark date. For example, if the due date is April 30 and the postmark

LINE 3: TOTAL TIRES AND LEAD-ACID BATTERIES SOLD —

is May 15, the payment is 15 days late.

Enter the total of Line 1C plus Line 2C.

Example: If interest rate is three percent (3%) and Line 7 is $480:

LINE 4: TIRE AND LEAD-ACID BATTERY FEE RATE — The

(A) Divide the annual interest rate by 365* to get a daily rate.

amount indicated on this line represents the Tire and Lead-Acid Bat-

(.03 / 365 = .0000822)

tery Fee rate.

(B) Multiply Line 7 by the daily rate.

LINE 5: TIRE AND LEAD-ACID BATTERY FEE — Line 3 (Total

($480 X .0000822 = .03946)

Tires and Lead-Acid Batteries Sold) multiplied (x) by Line 4 (Rate) =

Line 5 (Tire and Lead-Acid Battery Fee).

(.03946 X 15 days late = .59)

LINE 6: COLLECTION DEDUCTION — Enter six percent (6%) of

$ .59 is interest for late payment.

the amount shown on Line 5.

NOTE: Divide the annual interest rate by 365 to figure the daily rate.

LINE 7: TOTAL FEES DUE — Line 5 (Tire and Lead-Acid Battery

Fee) minus (-) Line 6 (Collection Deduction) = Line 7 (Total Fees

*Use 366 for leap years.

Due).

The annual interest rate is subject to change each year. You can

LINE 8: ADDITION TO FEES — For failure to pay Tire and Lead-

access the annual interest rate on the Department’s web site at:

Acid Battery Fee Return on or before the due date, enter five percent

(5%) of Line 7. For failure to file a Tire and Lead-Acid Battery Fee

Return on or before the due date, enter five percent (5%) of Line 7

for each month late up to a maximum of twenty-five percent (25%) (5

months late in filing = 25%).

For additional information visit

DOR-5068 (02-2013)

Form 5068 - Tire And Lead-Acid Battery Fee Return

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