EW1
2016 E-Waste Annual Registration Fee
Due August 15, 2016, for periods July 1, 2015, through June 30, 2016.
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 If you sold more than 100 video display devices (VDDs) to Minnesota households during the
previous period, enter $2,500 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
2 Total pounds of VDDs you sold to Minnesota households (from line 4 of Schedule A) . . . . . . . . . . . . . . . 2
3 Weight you are required to recycle:
a Multiply line two by 80% (.80) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3a
b If you received a minimum recycling obligation on July 30, 2015, . . . . . . . . 3b
enter it here. Otherwise enter zero.
Weight you are required to recycle (enter the larger of line 3a or 3b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
4 Pounds of covered electronic devices (CED):
a 11-county metropolitan area (from line 3 of Schedule B1) . . . . . . . . . . . . 4a
b Greater Minnesota (from line 5 of Schedule B2) . . . . . . . . . . . . . . . . . . . . . 4b
c Allowable carryover from last year (from line 4 of Schedule C) . . . . . . . . . 4c
Add lines 4a, 4b and 4c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
5 Determine the recycle credits available.
a If line 4 is more than line 3, subtract line 3 from line 4 . . . . . . . . . . . . . . . . 5a
This is the carryover credit for next year.
Skip lines 5 — 8 and enter the amount from line 1 on line 9.
If line 3 is more than line 4, subtract line 4 from line 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
.
6 Percentage of CED you recycled (divide line 4 by line 3) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
7 Price per pound: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
If line 6 is:
enter:
• 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-
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