Form 18rem - Energy Conservation Improvement Fund Program Remittance
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1Energy Conservation Improvement
FORM
18REM
Fund Program Remittance
PLEASE DO NOT WRITE IN ThIS SPACE
RESET
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Nebraska Identification Number
Federal Employer I .D .
Month and Year of Remittance
NAME AND LOCATION ADDRESS
NAME AND MAILING ADDRESS
Name Doing Business As
Name
Legal Name
Street Address
Street or Other Mailing Address
City
State
Zip Code
City
State
Zip Code
1 Enter the amount of state sales tax collected from customers in the prior calendar year . . . . . . . . .
1
2 Enter 5% of line 1 (Multiply line 1 by .05) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2
3 Remittances previously made within this calendar year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3
4 Remaining authority for matching funds (line 2 minus line 3) (see instructions) . . . . . . . . . . . . . . . . .
4
5 Amount remitted with this form (cannot exceed line 4) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5
Under penalties of law, I declare that I have examined this form, and to the best of my knowledge and belief, it is correct and complete .
sign
here
Authorized Signature
Date
Telephone Number
Title
E-Mail Address
INSTRUCTIONS
WhO MAY FILE. Every entity choosing to fund and maintain an Energy Conservation Improvement Fund subaccount
under the Nebraska Low-Income Home Energy Conservation Act must file this form.
Funds remitted by the 15th of the month will be available for distribution beginning on the first day of the following month.
If remitted after the 15th day of the month, the funds will not be available for distribution until the first day of the second
month following remittance.
PAYMENT METhOD. Payment must be made by check. Electronic payment (ACH) will not be accepted for this program.
No penalty will be assessed even though you may otherwise be subject to mandatory electronic payment requirements for
other tax programs.
LINE 4. The “remaining authority” is the amount of state funds the utility may match with its own funds and remit to its
Energy Conservation Improvement Fund subaccount during the remainder of the current calendar year. The total calendar
year remittances are limited to five percent of the state sales tax collected from customers by the utility during the previous
calendar year.
Mail this form to: NEBRASKA DEPARTMENT OF REVENUE, P.O. BOX 94818, LINCOLN, NE 68509-4818
, (800) 742-7474 (toll free in NE and IA), (402) 471-5729
6-490-2009 Rev . 6-2009
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