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					                                  2009 Natural Gas Excise Tax Annual Statement
                                             From January 1, 2009 Through December 31, 2009
                                                      Ohio Department of Taxation
                                                             Public Utility Tax Section
                                                                    P. O. Box 530
                                                          Columbus, Ohio 43216 - 0530

         Send completed statement to the Tax Commissioner. Payment may be made to the Treasurer of State by electronic funds transfer.


                    Telephone (614) 466-7371                                                                        Fax (614) 752-2496

                          Public Utility Information
Name:                                                                                   FEIN:
Address:
                                                                                        State of Inc.


City:                                                               Due Date            Date of Inc.
State:                                                          This statement and Ohio Charter #:
Zip:                                                            payment are due on Entity Type:
                                                                     or before

Contact:                                                          February 14, 2010               For Department Use Only                            Initial
                                                                                    Date Received TOS
Phone:                                                            Payment may be Date Received DOT
                                                                 made by electronic Audit Completed
E-mail:                                                            funds transfer   Audit Reviewed
                                                                                    Assessment
                          Gross Receipts Tax Calculation
                     1    OHIO TAXABLE GROSS RECEIPTS (Line 26, Column J)                                                                              1
 Tax Calculation




                     2    LESS 25,000 DEDUCTION                                                                                        (25,000)        2

                     3    TAXABLE GROSS RECEIPTS (Line 1 less Line 2)                                                                                  3

                     4    TAX RATE                                                                                                        4.75%        4

                     5    TAX OWED (Line 3 x Line 4)               Minimum Tax is $ 50.00                                                              5



I declare under penalties of perjury that this report, including any accompanying schedules or statements, has been examined by me and to the
best of my knowledge and belief is a true, correct and complete report. This public utility has not, during the preceding year, except as permitted
by sections 3517.082, 3599.03, and 3599.031 of the Revised Code, directly or indirectly used any of its money or property for or in aid of or
opposition to a political party, a candidate for election or nomination to a public office, or a political action committee, legislative campaign fund, or
organization that supports or opposes any such candidate or in any manner used any of its money or property for any partisan political purpose
whatever, or for the reimbursement or indemnification of any person for money or property so used.



                   Date                  Signature                                                              Title
                                                                        Page 1
                  NATURAL GAS & NON UTILITY ACTIVITIES                  -   GROSS RECEIPTS

COMPANY NAME:                                                                            FEIN:

 L                                                                                                     (D)
                                                (A)               (B)                (C)
 I                                                                                                 TOTAL OHIO
 N     SOURCE OF GROSS RECEIPTS            TOTAL GROSS        INTERSTATE       BUSINESS DONE
                                                                                                   INTRASTATE
 E                                           RECEIPTS          BUSINESS       IN OTHER STATES
                                                                                                    RECEIPTS


 1   RESIDENTIAL

 2   COMMERCIAL

 3   INDUSTRIAL

 4   OTHER SALES TO PUBLIC AUTHORITIES

 5   GAS SALES FOR RESALE

 6   GAS BILLED FOR OTHERS

 7   TRANSMISSION OF GAS - GATHERING

 8   TRANSMISSION OF GAS - DISTRIBUTION

 9   TRANSMISSION OF GAS - TRANSMISSION

10   STORING GAS OF OTHERS

11   RENTS

12   PLANT LEASED TO OTHERS

13   SALES OF PRODUCTS EXTRACTED - GAS

14   NATURAL GAS PROCESSED BY OTHERS

15   INCIDENTAL GASOLINE & OIL SALES

16   OTHER OPERATING RECEIPTS

17   MERCH., JOBBING & CONTRACT WORK

18   MISCELLANEOUS SERVICE

19   FORFEITED DISCOUNTS

20   NON UTILITY OPERATIONS

21   NON UTILITY RENTAL

22   NON UTILITY MERCHANDISE

23   NON UTILITY MISCELLANEOUS

24

25

26 TOTAL

        See instructions for information on how to complete this schedule and columns for which additional
                                                     Page 2
                 FROM JANUARY 1, 2009 THROUGH DECEMBER 31, 2009
                                     Round all amounts to the nearest dollar.
COMPANY NAME:                                                                           FEIN:
       (E)
                        (F)                                                          (I)                         L
 BUSINESS DONE                              (G)                     (H)                               (J)
                  SALES TO OTHER                                                   TOTAL                         I
  FOR OR WITH                             SALE OF             GAS BILLED FOR                     OHIO TAXABLE    N
                  PUBLIC UTILITIES                                              INTRASTATE
    FEDERAL                             MERCHANDISE              OTHERS                         GROSS RECEIPTS   E
                    FOR RESALE                                                  DEDUCTIONS
  GOVERNMENT

                                                                                                                 1

                                                                                                                 2

                                                                                                                 3

                                                                                                                 4

                                                                                                                 5

                                                                                                                 6

                                                                                                                 7

                                                                                                                 8

                                                                                                                 9

                                                                                                                 10

                                                                                                                 11

                                                                                                                 12

                                                                                                                 13

                                                                                                                 14

                                                                                                                 15

                                                                                                                 16

                                                                                                                 17

                                                                                                                 18

                                                                                                                 19

                                                                                                                 20

                                                                                                                 21

                                                                                                                 22

                                                                                                                 23

                                                                                                                 24

                                                                                                                 25

                                                                                                                 26

 detail must be provided.
                                                            Page 3
                                                INSTRUCTIONS FOR COMPLETING
                                           NATURAL GAS EXCISE TAX ANNUAL STATEMENT

Please note that this statement is to be used to report all natural gas activities gross receipts (activities of supplying natural gas to consumers for lighting,
power, or heating purposes) and all other activities (nonutility). The gross receipts should be reported on what you actually received, i.e. cash or equivalent,
for the period January 1, 2009 through December 31, 2009. Amounts should be rounded to the nearest dollar.


If you have a source of gross receipts that are not listed on the statement, you must list those receipts in the blank spaces provided. If you need
additional space you may attach a supplemental schedule. Whether taxable or not, all business gross receipts must be listed on this schedule.

Explanation of the columns of the Report.

(A) Total Gross Receipts: Enter the total gross receipts for all business done, including nonutility activities.

(B) Interstate Business: Enter all gross receipts derived wholly from interstate business. IF OVER $ 10,000, ATTACH A BREAKDOWN LISTING EACH
ENTITY AND THE AMOUNT PER ENTITY THAT AN EXEMPTION IS CLAIMED.

(C) Business Done in Other States: Enter all gross receipts from intrastate business provided entirely in a state other than Ohio. IF OVER $10,000,
ATTACH A BREAKDOWN LISTING THE STATES AND THE AMOUNT PER STATE THAT AN EXEMPTION IS CLAIMED.


(D) Total Ohio Intrastate Receipts: Subtract columns B and C from column A - Only business done in Ohio should be claimed on the columns below.

(E) Business Done For or With the Federal Government: Enter all gross receipts for business done in Ohio for or with the federal government. Federal
government does not include state and local agencies such as the Ohio National Guard, schools, colleges, and non-federal organizations wholly or partially
funded by the federal government. IF OVER $10,000, ATTACH A BREAKDOWN LISTING EACH FEDERAL AGENCY AND THE AMOUNT PER AGENCY
THAT AN EXEMPTION IS CLAIMED.

(F) Sales to Other Public Utilities for Resale: Enter all gross receipts from sales to other public utilities in Ohio (taxable as public utilities under Chapter
5727 of the Revised Code) for resale, excluding telephone companies, railroads, electrics, rural electrics and interexchange telecommunications companies.
Do not include a public utility located in or outside of Ohio that is not subject to the gross receipts excise tax (5727.24 or 5727.30 R.C.) under this column. If
exempt, sales located outside of Ohio should be reported under Column B. IF OVER $10,000, ATTACH A BREAKDOWN LISTING EACH PUBLIC UTILITY
AND THE AMOUNT PER PUBLIC UTILITY THAT AN EXEMPTION IS CLAIMED.


(G) Sale of Merchandise: Enter all gross receipts from the sale of merchandise in Ohio. Merchandise includes items of tangible personal property such as
equipment, appliances, and also includes food and beverages, that is sold in the ordinary course of business. It does not include the sale of services or the
gross receipts derived from the rental or lease of property. Items subject to Ohio's sales tax do not automatically come within this deduction. YOU MAY BE
ASKED TO PROVIDE ADDITIONAL DETAIL ON THE MERCHANDISE CLAIMED AS AN EXEMPTION.

(H) Gas Billed for Others: Enter all gross receipts from gas billed on behalf of other entities in Ohio, excluding transportation and other billing and collection
fees charged to other entities. IF OVER $10,000, ATTACH A BREAKDOWN LISTING EACH ENTITY AND THE AMOUNT PER ENTITY THAT AN
EXEMPTION IS CLAIMED.

(I) Total Intrastate Deductions: Add Columns E, F, G and H.

(J) Ohio Taxable Gross Receipts: Subtract Column I from Column D.

The total on Line 26, Column J, (Ohio Taxable Gross Receipts) should be entered in the tax calculation portion of this statement.

If you have questions?

Please contact the Public Utility Tax Section at (614) 466-7371 or Fax (614) 752-2496.

This statement and all accompanying schedules should be sent to:
                                                                                                                          Questions about Electronic Funds
             Address for U.S. Postal Service:                      Address for other delivery services:                   Transfer:
             Department of Taxation                                Department of Taxation                                 Treasurer of State
             Personal Property Tax Division                        Personal Property Tax Division                         Attn: Don Thomas
             Public Utility Tax Section                            Public Utility Tax Section                             30 East Broad Street, 9th Floor
             PO Box 530                                            30 East Broad Street, 21st Floor                       Columbus, OH 43215
             Columbus, OH 43216-0530                               Columbus, OH 43215
                                                                                                                          (614) 752-8482

                                                                               Page 4

				
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