Form 28 - formuPack

Nebraska Litter Fee Return
Nebraska ID Number
Due Date
Period Covered by Return
Check this box if you have discontinued your business.
If you have more than one business location making sales in this state, refer to the paragraph
titled “Persons With More Than One Location” in the instructions on the reverse side.
1 Gross proceeds from the manufacture and sale, and sale at wholesale in this state of products and
by-products subject to the litter fee......................................................................................................................
2 Gross proceeds from the retail sale of products and by-products in this state subject to the litter fee.................
3 Enter the greater of line 1 or line 2, unless the amount to be entered on line 3 is less than
$100,000. If the amount is less than $100,000, enter zero (-0-)............................................................................
4Nebraska litter fee (line 3 multiplied by ).......................................................................................
5 Previous balance with applicable interest at
% per year and payments received through
Check this box if your payment is being made electronically.
6 BALANCE DUE (line 4 plus line 5). Pay in full with return.....................................................................................
Under penalties of law, I declare that I have examined this return, and to the best of my knowledge and belief, it is correct and complete.
( )
Authorized Signature
Daytime Phone
Signature of Preparer Other Than License Holder
Email Address
Who Must File. Every person who has annual gross proceeds
from sales in Nebraska of products subject to the litter fee from all
locations of at least $100,000 must obtain a litter fee license. A litter
fee license can be obtained by filing a Nebraska Tax Application,
Form 20. A separate application for a litter fee license is required
for each place of business in Nebraska.
The Nebraska litter fee and the Nebraska waste reduction and
recycling fee are separate programs. It is possible that your
company is required to pay both fees.
Out-of-state manufacturers, wholesalers, and retailers report only
the gross proceeds from Nebraska sales of items specified in the
line 1 and line 2 instructions on this return. The Nebraska Litter
Fee Information Guide can be found on the Department’s website
When and Where to File. This return, properly signed and
accompanied by a check or money order payable to the Nebraska
Department of Revenue, will be considered timely filed if
postmarked on or before the due date stated on the face of the return.
Mail this return and payment to: Nebraska Department of Revenue, PO Box 94818, Lincoln, NE 68509-4818, 800-742-7474 (NE and IA), 402-471-5729
Please make a copy of this return for your records.
5-215-1996 Rev. 7-2013
Supersedes 5-215-1996 Rev. 8-2011
The litter fee return must be filed even if the amount reported on
line 3 is zero.
Preidentified Return. This return is to be used only by the
manufacturer, wholesaler, or retailer whose name is printed on
it. If you have not received a preidentified return for the period
covered by the return, request a duplicate from the Nebraska
Department of Revenue (Department). Do not file returns which
are photocopies, returns for another period, or returns which have
not been preidentified.
Name/Address Changes. If your business name has changed
and is a name change only (i.e., the ownership or federal
identification number has not changed), mark through the name,
plainly print the new name, and write “name change only” on the
return. A change in ownership or type of ownership (e.g., individual
to a partnership, partnership to a corporation, etc.) will require you
to cancel your license and apply for a license for the new entity.
The new owner of the business should not file a return using the
previous owner’s preidentified litter fee returns. The new owner
must complete a Nebraska Tax Application, Form 20, to obtain a
litter fee license.
If there is a change or correction in the name and address, mark
through the incorrect information and plainly print the correct
information. If this is the result of a relocation of your business,
indicate this by writing “relocated” on the return. Reminder:
A litter fee license is required for each location. If there is an
additional location opened, you must apply for another litter fee
license by filing a Nebraska Tax Application, Form 20.
Persons With More Than One Location. Every manufacturer,
wholesaler, or retailer who owns 80 percent or more of two or
more locations that sell products subject to the litter fee must
license each location and file one “combined” litter fee return. The
“combined” filing requires the calculation of the litter fee on the
total annual gross receipts from sales by all locations of products
subject to the litter fee. A Nebraska Application for Permission to
File a Monthly Combined Sales and Use Tax or Combined Litter
Fee Return, Form 11, must be submitted to obtain a “combined”
Nebraska identification number.
Discontinuation of Business. A license holder who
discontinues selling products subject to the litter fee may cancel the
litter fee license. License holders who have filed a litter fee return
for previous reporting periods, but for the current reporting period
have less than $100,000 in annual gross proceeds, may terminate
their litter fee license. The Department recommends that license
holders not cancel their license if there is a reasonable expectation
that the litter fee gross proceeds for the next reporting period will
exceed $100,000.
Reinstatement of License. The litter fee license for any
particular location may be reinstated upon the license holder’s
request without charge by filing a Nebraska Change Request,
Form 22.
Penalty and Interest. In the event that the return is not filed by
the prescribed due date, a penalty will be assessed in the amount
of $25 or ten percent of the fee due, whichever is greater. Interest
will be assessed on any unpaid fee at the rate printed on line 5
from the due date until payment is received.
Verification and Audit. Records to substantiate this return
must be retained and available for a period of at least three years
following the date of filing the return.
Specific Instructions
Line 1. Enter the total gross proceeds from the manufacture
and sale, and sale at wholesale in this state of products and byproducts, from all locations, which fall into any of the following
categories: (1) food for human or pet consumption; (2) cigarettes
and other tobacco products; (3) soft drinks and carbonated waters;
(4) liquor, wine, beer, and other malt beverages; (5) household
paper and household paper products, excluding magazines,
periodicals, newspapers, and literary works; (6) glass containers;
(7) metal containers; (8) plastic or fiber containers made of
synthetic material; (9) cleaning agents and toiletries; and (10)
kitchen supplies.
Line 2. Enter the total gross proceeds from the sale at retail in
Nebraska of the products from all locations which fall into any of the
following categories: (1) food for human consumption, beverages,
soft drinks, carbonated water, liquor, wine, beer, and other malt
beverages, except those sold by retailers solely for consumption
indoors on the retailers’ premises; (2) food and beverages sold
through a vending machine; (3) food for pet consumption; (4)
cigarettes and other tobacco products; (5) household paper and
household paper products, excluding magazines, periodicals,
newspapers, and literary works; (6) cleaning agents; and (7)
kitchen supplies.
Line 4. Compute the fee by multiplying line 3 by the applicable
rate. Carry the decimal to three places and round to two places.
For example, $17.754 should be shown as $17.75, while $17.755
should be shown as $17.76.
Line 5. A balance due or credit (indicated by “subtract”) resulting
from a partial payment, mathematical or clerical errors, penalty,
or interest relating to prior returns will be entered in this space by
the Department. The amount of interest includes interest on the
unpaid fee through the due date of this return. If the amount due
is paid before the due date, the interest will be recomputed and a
credit will be given on the next return. If the amount entered has
been satisfied by a previous remittance, it should be disregarded
when computing the amount to remit on line 6.
Line 6. Electronic payments may be made using any of the
following options:
Department’s e-pay program (the State withdraws
funds from your bank account based on the information
you provide);
ACH Credit (you work with your bank to deposit funds
into the State’s bank account);
• Nebraska Tele-pay (pay by calling 800-232-0057); or
• Credit card payments.
To find more information about these electronic payment options,
see the Electronic Payment Options for State Taxes page on the
Department’s website. Those not mandated to pay electronically
may attach a check or money order for the amount on line 6, made
payable to the Nebraska Department of Revenue.
Signatures. This return must be signed by the license holder,
partner, corporate officer, or member of an LLC. If the license
holder authorizes another person to sign this return, there must
be a power of attorney on file with the Department or attached
to the return.
Any person who is paid for preparing a license holder’s return
must also sign the return as preparer.