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'm-' <br /> Sw- 1 <br /> <br />I'ACILITY <br /> <br />m <br /> <br /> MINNESOTA DEPARTMENT OF <br />MIXED MUNICIPAL SOLID <br /> <br />LOCAIION: CITY/TOWN <br /> <br />WASTE FEE <br /> <br />REVENUE <br /> <br />MONTHLY REPORT <br /> <br /> ICOUNTY.. tu~ol:~ <br /> <br />Factlity Name and Address <br /> Waste F~r~ge~nt of J~J[n~sot& Znc <br /> 14730 Sunfiah ~ Blvd <br /> ~oka, ~{ 553Q~ ' <br /> <br /> ~eturn for the ~onth of ~e~ <br />I,. <br /> <br />m <br /> <br />m <br /> <br />m4 <br /> <br />m <br /> <br />Minnesota Tax Identification Number <br /> 36-2698820 <br /> <br /> , Year 1985 <br /> <br />FACILITIES THAT WEIGH THE WASTE - total pounds received during the month <br />of 8rS17t220 Divide the total pounds received, by 600. <br />The result is cubic yards. Enter on line I. <br /> <br />FACILITIES THA1 MEASURE THE WASTE - enter the total cubic yards received <br />during the month on line 2. <br /> <br />Total cubic yards received during the month. Add the amounts on lines 1 <br />and 2, and enter the result on line 3. <br /> <br />Total cubic yards of waste residue received from energy and resource <br />recovery facilities during the month of <br />Multiply this amount by 50% and enter on line 4. (ATTACH STATEMENT OF <br />EXEMPTIONS) <br /> <br />1. 14,695 <br /> <br />2. 39,141 <br /> <br />3. 53,936 <br /> <br />5. <br /> <br />Total cubic yards of non-hazardous waste from metalcasttng facilities and <br />other exempt material Enter the amount on )ine S. <br />(ATTACH STATEMENT OF EXEMPTIONS) <br /> <br />Add the amounts on lines 4 and 5. Enter the total on Tine 6. <br /> <br />-0- <br /> <br />m <br />I <br />m <br />I <br />m <br />m <br /> <br />Substract the amount on line 6 from the amount on line 3. <br />result on line 7. <br /> <br />Enter the <br /> <br />Column A Column B <br />Computed Flat Fee <br />Amount Autos, Pickups, <br /> etc. <br /> <br />7. 53,836 <br /> <br /> Add the amounts in Columns A <br /> and B, Lines SA, 8B and 8C. <br />Multiply the amount on line 7 This is the amount due each <br />by the following fees: agency. <br /> <br />A. Line 7 by $.50, State Fee $ 26,918.00 $ .301.50 State Fee $ ~7,29~.5C <br /> <br />B. Line 7 by $.25, County Fee $ 13,459.00 -~..$ 190.75 County Fee $ 13,649.75 <br /> /. <br /> <br />C. Line 7 by $.15, City Fee $ 8,075.40 $ 114.45 ClTYFEE $ 8,189.1~5 <br /> <br /> I declare, under the penalties of perjury and criminal liability for willfully making a false return, that this return <br /> is true and complete~ to the;_/. / best ~f my knowledge and bilief. I confess judgment to the State of Minnes~ta,for the tax <br /> due, if no,/timely paid. _ // ' <br /> <br />y'~J~nature / .7 lit1. Date -' <br /> <br />PLEASE SEND THIS COPT TO THE CITY. ALONG WITH THE CITY FEE <br /> <br /> <br />