IiiIndiana Department of Revenue HW-020 State Form 46244 (R / 3-09) Hazardous Waste Disposal Tax Return The Department of Revenue will not process any application which does not contain a Federal Identification Number or Social Security Number and a signature of owner or officer of the company. Quarter Ending , 20 Due The 20th Day After The End Of The Quarter Taxpayer’s Name: Federal I.D. Number: Mailing Address: City: State: Disposal Facility Name: County of Disposal Facility 1. Enter the total tons of hazardous waste disposed by underground injection during the calendar quarter (attached Schedule HW-021). Zip Code: >>> 2. Tax Due (multiply Line 1 by the current tax rate - see instructions). 3. Enter the total of all previous hazardous waste tax paid on underground injection for the current year. 4. Total hazardous waste tax for the calendar year (Line 2 plus Line 3). A. B. C. D. If Line 3 is greater than or equal to $25,000.00, enter zero (-0-) on Line 5. If Line 4 is greater than or equal to $25,000.00, but Line 3 is zero (-0-), enter $25,000.00 on Line 5. If Line 4 is less than $25,000.00, enter the figure from Line 2 on Line 5. If Line 2 is less than $25,000.00, but Line 4 is greater than $25,000.00, enter the difference of $25,000.00 minus Line 3 on Line 5. ************************************** Read Instructions before entering an amount on Line 5. ************************************** 5. Net tax due on underground injection for the current calendar quarter. > Section II: Disposal by Other Methods - Hazardous Waste Generated in Indiana >> 6. Enter the total tons of hazardous waste generated in and disposed of in Indiana (attach Schedule HW-021). 7. Tax Due (multiply Line 6 by the current tax rate - see instructions). Section III: 8. Enter the total tons of hazardous waste generated outside of Indiana and subsequently disposed of in Indiana (attach Schedule HW-021). >> 9. Tax due (multiply Line 8 by the out of state tax rate of the state in which the hazardous waste was generated or the current Indiana tax rate, Whichever is Greater - see instructions). >> Section IV: Amount Due 10. Total tax due (enter the total of Line 5, 7 and 9). 11. Penalty (10% of Line 10, if filed after the due date). 12. Interest (if filed after the due date, see instructions). 13. Total amount due (enter the total of Line 10, 11 and 12). I hereby declare under the penalty of perjury that the information contained in this return, including accompanying schedules and statements, is true, correct and complete to the best of my knowledge and belief. Signature of Taxpayer or Duly Authorized Agent Print or Type Name Title Telephone Number Date Make Check Payable to: Indiana Department of Revenue and mail the completed return and check to: Indiana Department of Revenue, Excise Tax Section: Environmental, 100 N. Senate Ave. American LegalNet, Inc. Indianapolis, Indiana 46204-2253 www.FormsWorkflow.com Instructions for Completing Form HW-020 A tax is imposed on the disposal of hazardous waste in Indiana. The operator of the disposal facility is liable for this tax. Statutory provisions governing this tax are cited in Indiana Code 6-6-6.6. Tax Rates The tax is $11.50 per ton of waste disposed. If the waste is generated outside Indiana, and is transported here for disposal, you must compare the Indiana rate of $11.50 per ton with the origin state’s rate imposed on out of state hazardous waste. The greater of the two is the rate you use to calculate the Indiana disposal tax. Due Dates Your calendar quarter liabilities are due: April 20, July 20, October 20 and January 20. Section I The maximum liability for disposal by underground injection is $25,000.00 annually. Section I is designed to reflect that limit. Once you have paid the $25,000.00 annual limit, you don’t owe any more tax for the year; however, you should continue to report the amount of underground injection disposal tonnage. Section II Waste that is both generated in Indiana and disposed of in Indiana is currently taxed at the rate of $11.50 per ton. Section III Waste that is generated outside Indiana and brought here for disposal is taxed at the greater of the Indiana rate of $11.50 per ton or the rate the generating state imposes on out of state hazardous waste. Section IV The total tax due from underground injection, disposal of in-state waste, and disposal of out of state waste is summarized here. If your payment is postmarked after the due date, you owe penalty and interest. The penalty is ten percent (10%) of the total tax due. The interest changes annually. Call the Department at (317) 615-2590 for the current interest rate. If your payment is late, and you fail to include penalty and interest, you will be billed. If you owe no tax (i.e., Line 10 is zero), you do not owe penalty or interest. If you have questions about the calculation of this tax, contact the Indiana Department of Revenue at (317) 615-2544. American LegalNet, Inc. www.FormsWorkflow.com