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MINNESOTA DEPARTMENT OF REVENUE <br />�a'1 MIXED MUNICIPAL SOLID WASTE FEE MONTHLY REPORT <br />I CIL1TY LOCATION: <br />CITY /TOWN %anoc v <br />COUNTY Anoka <br />W of <br />acility Name and Address Minnesota Tax Identification Dumber <br />'7:r) Sunfish Lal:n Loul%varcl 36 -3F92820 <br />turn for the Month of .7unn v-.- •nee <br />FACILITIES THAT WEIGH THE WASTE - total pounds received during the month <br />of 10,495,380 Divide the total pounds.received, by 600. <br />The result is cubic yards. Enter on line 1. - . <br />FACILITIES THAT MEASURE THE WASTE - enter the total cubic yards received <br />during the month on line 2. - <br />Total cubic yards received during the month. Add the amounts on lines 1 <br />and 2, and enter the result on l ine 3. <br />Total cubic yards of waste residue received from energy and resource <br />recovery facilities during the month of -0- ` <br />Multiply this amount by 50% and enter on line 4 . (ATTACH STATEMENT OF <br />EXEMPTIONS) <br />Total cubic yards of non - hazardous waste from metalcasting facilities and <br />other exempt material 32 Enter the amount on line S. <br />(ATTACH STATEMENT OF EXEMPTIONS) <br />Add the amounts on lines 4 and S. Enter the total on line 6. <br />Substract the amount on line 6 from the amount on line 3. Enter the <br />result on line 7. <br />Column A - Column B <br />Computed Flat Fee <br />Multiply the amount on line 7 Amount Autos, Pickups, <br />by the following fees:-- - - - --- - - etc.- <br />1. 17,492 <br />2. . 44,830 <br />3. <br />62,322 <br />Line 7 by <br />4. <br />-o- <br />f <br />5. <br />32 <br />1635.50 <br />6. <br />32 <br />7. 62,290 . <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 />A. <br />Line 7 by <br />$.50, <br />State Fee <br />f <br />31,145.00 <br />f <br />1635.50 <br />State Fee $ <br />32,760.50 <br />B. <br />Line 7 by <br />$.25, <br />County Fee <br />f <br />15,572.50 <br />f <br />017.75 <br />County Fee $ <br />161390.25 <br />' <br />C. <br />Line 7 by <br />$.15, <br />City Fee <br />S <br />9,3- 93.50 <br />$ <br />490.65 <br />CITY FEE $ <br />4 , 034 .15 <br />declare, <br />under the <br />penalties <br />of perjury <br />and criminal liability <br />for <br />willfully making a <br />false return, <br />that this return <br />true <br />and <br />complete <br />to the <br />best of my <br />knowledge and belief. I <br />confess judgment to the <br />State of Minnesota for the tax <br />due, if <br />not <br />timely paid. <br />gnature <br />Title <br />Date <br />'EASE SEND THIS COPY TO THE CITY, ALONG WITH THE CITY FEE <br />