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MINNESOTA DEPARTMENT OF REVENUE <br /> <br />MIXED MUNICIPAL SOLID WASTE FEE MONTHLY REPORT <br /> <br />LOCATION: C1TY/TO~N ~:.~ey COUNTY <br /> <br />'m <br /> IFACILITY <br /> <br /> IIFacility Name and Address <br /> A~okd SanitJry I,and~l] <br /> P.O. Bo~ 67 <br /> Anckat Mrl 55303 <br /> <br />Minnesota Tax Identification Number <br /> 36-3698920 <br /> <br /> Return for the Month of pp~]]. , Year )9B5 <br />m 1. FACILITIES THAT WEIGH THE WASTE - total pounds received during the month <br /> of 11,1U4,020 Divide the total pounds received, by 600. <br /> The result is cubic yards. Enter on line 1. <br /> <br />m <br /> <br />m 4. <br /> <br />m <br /> <br />FACILITIES THAT 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. la,64~ <br /> <br />62,941 <br /> <br />3. 81,581 <br /> <br />m5. <br /> <br />m-6. <br /> <br />Total cubic yards of non-hazardous waste from metalcasting facilities and <br />other exempt material 122 Enter the amount on line S. <br />(ATTACH STATEMENT OF EXEMPTIONS) <br /> <br />112 <br /> <br />Add the amounts on lines 4 and 5. Enter the total on line 6. <br /> <br />6. 112 <br /> <br />Substract the amount on line 6 from the amount on line 3. Enter the <br /> <br />7. 81,469 <br /> <br />Column A Column B <br />Computed Flat Fee <br />Amount Autos, Pickups, <br /> etc. <br /> <br />Add the amounts in Columns A <br />and B, Lines 8A, 8B and 8C. <br />This is the amount due each <br />agency. <br /> <br />$ 40,234~50 $ 1531.50 <br />$ 20,367.25 $ 765.75 <br />$ 12,220.35 $ 459.45 <br /> <br />State Fee $ 42,266.C2 <br /> <br />County Fee $ 21,133.0C <br /> <br />CITY FEE $ 12,679.5o <br /> <br />Multiply the amount on line.7 <br />by the following fees: <br /> <br /> Line 7 by $.50, State Fee <br /> Line 7 by $.25, County Fee <br /> Line 7 by $.15, City Fee <br /> <br />I declare, under the penalties of perjury and criminal liability for willfully making a false return, that this retur~ <br />is true and.complete to the best of my knowledge and belief. I confess Judgment to the State of Minnesota for the <br />due, if not timely paid': <br /> <br />Hay 15, 1985 <br /> <br />Division uontroller <br /> <br /> Title <br /> <br /> ; / <br /> <br />I~LEASE SEND THIS COPT TO THE CITY, ALONG ¥ITH THE CITY FEE <br /> <br />Date <br /> <br /> <br />