Indiana Department of Revenue Indiana Utility Receipts Tax Returns This form can be used for remitting the required quarterly estimated tax payments for the current calendar year (or taxable fiscal year) or for remitting your extension payment. Do not use Form URT-Q(w) to remit any other income tax payments. The annual Utility Receipts Tax Return, Form URT, is available as a separate form. If a taxpayer’s annual tax liability exceeds $2,500, the taxpayer is required to file quarterly estimated payments and remit 25% of the estimated annual tax due on each quarterly return. Assistance and preprinted quarterly payment coupons may be obtained by calling the Tax Administration at 317-233-4015. If the taxpayer’s annual liability exceeds $40,000, the taxpayer is required to pay the quarterly estimated tax liability by electronic funds transfer (EFT). If the payment is made by EFT, the taxpayer is not required to file an estimated return. The EFT registration form, EFT-1, can be obtained on the Department’s Web site (www.in.gov/dor/3489.htm). Questions concerning the EFT registration process can be directed to departmental personnel by calling (317) 615-2695. Instructions Completing Form URT-Q(w) for Quarterly Payments Completing Form URT-Q(w) for an Extension Payment The quarterly estimated utility receipts tax return with payment is due on the 20th day of the 4th, 6th, 9th, and 12th months of the taxable year (regardless of whether you’re filing on a calendar-year or fiscal-year basis). The extension payment is due on the 15th day of the 4th month following the close of the tax year. Compute 25% of the annual estimated utility receipts tax or the exact amount of tax for the quarter. You may reduce the quarterly estimated payment by the amount of your overpayment of tax from a prior year that was applied to your estimated account. Enter the net amount on the appropriate remittance form. An authorized officer must sign and date each remittance form. Mail payment by your quarterly return due date. The utility receipts tax rate is 1.4%, effective Jan. 1, 2003. This Web version of Form URT-Q can be used to make an extension payment. It is to be used when a payment is due and additional time is necessary for filing the annual utility receipts tax return. A penalty for late payment will not be imposed if at least 90% of the annual tax due is paid by the original due date and the remaining balance, plus interest, is paid in full by the extended due date. Also, a copy of the federal extension of time to file form must be enclosed with the annual return when filed. The U.S. Postal Service postmark date is used to determine if a return is timely. Please be aware of the local postal service’s hours of mail pickup. Refer to Commissioner’s Directive #18 (www.in.gov/dor/reference/files/cd18.pdf) for more information. An annual URT reporting form with instructions is available at: www.in.gov/dor/3489.htm Payments must be made with U.S. funds. Please do not send cash or include check stubs when mailing your payments.  Taxpayer Name Form URT-Q(w) Street Address Federal ID Number City State Form State Utility Receipts Tax Payment R/(8-10) Zip Code Voucher - Check box to show which payment you are making: Signature of Officer  1st Quarter  2nd Quarter  3rd Quarter  4th Quarter  Extension Payment Date Calendar or Fiscal Year Ending Due Date Title Daytime Phone # ( ) Make check payable to the Indiana Department of Revenue. . . Estimated Utility Receipts Tax Due.           $ American LegalNet, Inc. www.FormsWorkFlow.com