Due on or Before
Taxpayer ID Number For Tax Period
Date Phone ______________________
(6206115(
INDIANA DEPARTMENT OF REVENUE
P.O. Box 7206
INDIANAPOLIS, IN 46207-7206
Authorized
Signature
I declare under penalties of perjury that this is a true, correct and complete return.
Filing Status
USU−103 0812
Total gross sales to Indiana consumers by utility
service providers collecting USUT.....................
Total amount due (Add Lines 5 through 8)......
Late payment penalty: If late, penalty is the
greater of $5 or 10% of Line 5.......................
Amount of consumer purchases from utility
service providers not collecting USUT..............
Adjustments − Attach proof for deductions.......
Total: Amount from Line 1 or 2 less Line 3....
USU Tax due: Line 4 amount X 0.014 (1.4%)
Interest due: If late compute annual interest on
amount from Line 5.........................................
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Instructions for Completing Form USU−103
(The following instructions are valid for this form only.)
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Remember to keep records of each USUT payment. Keeping an accurate record of your estimated tax payments will help resolve any delays in the processing
of your return. If your carryover credit has been adjusted, please revise your records so you may claim the proper amount on your next year’s annual tax return.
You must file a monthly return even if no tax is owed.
Make sure all preprinted information is correct for the tax period you are filing. Please sign and date each return.
1. Total gross sales to Indiana consumers by utility service providers collecting USUT − Enter the amount of gross receipts received for furnishing utility services on
which Utility Services Use Tax was collected on behalf of your Indiana customers for the retail consumption of utility services in Indiana during the period. The collection
of any general sales tax, Indiana utility receipts tax, or use tax paid to another state should not be included. Complete this line only if you are a utility service provider.
2. Amount of consumer purchases from utility service providers not collecting USUT − Enter the gross amount of all utility services purchased for retail. Complete
this line only if you are remitting as an Indiana consumer of utility services.
3. Adjustments − Enter the portion of receipts or amounts included on Line 1 or 2 on which USUT was paid on purchases from service providers or was otherwise exempt
from USUT. Documentation of any adjustment must be submitted with the return.
4. Total − Enter the amount from Line 1 or 2, minus the amount (if any) on Line 3.
5. Utility Services Use Tax due for the period − Multiply Line 4 by the tax rate of 1.4 percent (0.014).
6. Interest due − A payment made after the due date is subject to interest. Interest is computed from the tax due date to the date payment is postmarked. To calculate
interest, multiply the amount due by the annual interest rate and divide the result by 365. Multiply that result by the number of days the payment is late. Do not compute
interest on any late payment penalty entered on Line 7.
7. Late payment penalty − Payments postmarked after the due date are also subject to a 10 percent penalty. The penalty must be computed by multiplying 10 percent
(0.10) by the amount on Line 5 or $5, whichever is greater. Do not compute penalty on the interest amount due entered on Line 6.
8. Total amount due − Add Lines 5 through 8. This is the amount you owe. Make check or money order payable (in U.S. funds) to the Indiana Department of Revenue. If
the result is a negative figure, carry the net overpayment to the next month.
Please do not send cash. Make check payable (in U.S. funds) to the Indiana Department of Revenue.
For assistance, call the corporate tax information line at (317) 232−0129 or visit www.in.gov/dor/3392.htm.
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