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Ohio Tax Exempt Forms document sample
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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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