690018

     NEW OWNERS                                KANSAS DEPARTMENT OF REVENUE 
     Do not use previous                                     Division of Taxation 
     owner’s return                                                                                                                                                            FOR OFFICE USE ONLY 

                       ENVIRONMENTAL SURCHARGE AND SOLVENT FEE RETURN 
                                                         (See instructions on reverse side)                                                                                                          DC

                                                                                                                          Registration no.: 

                                                                                                                          Return for: 

                                                                               Must be filed and tax paid by: 
IF NO SERVICES SUBJECT TO THE SURCHARGE WERE RENDERED OR NO DRY CLEANING SOLVENT SOLD DURING THIS 
               REPORTING PERIOD—ENTER “0” ON LINE 8, PART I AND/OR LINE 5, PART II, SIGN AND RETURN.
PART I – ENVIRONMENTAL SURCHARGE (Retailers only) 
               1.   Total gross receipts or sales for this period (excluding the tax collected) . . . . . . . . . . . . . . . . . .                                          $
               2.   Deductions (from line E, Schedule I) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                         $
               3.   Net taxable receipts (subtract line 2 from line 1) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                             $
               4.   Surcharge (multiply line 3 by 2.5%) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                        $
               5.   Penalty (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                   $
               6.   Interest (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                  $
               7.   Credit memorandum (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                             $
               8.   Total environmental surcharge, penalty, and interest (add lines 4, 5, and 6 and subtract line 7)                                                         $ 

                                                                 Schedule I — Deductions 
     A.	  Dry cleaning or laundry services provided through an automatic or manual coin-operated device for use by the 
          general public . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ ____________________________ 
     B.	  Laundering or rental of uniforms, linens, dust control materials, or other textiles for commercial purposes, 
          without the use of dry cleaning solvents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .     $ ____________________________ 
     C. 	 Dry cleaning or laundry services rendered to entities that qualify for exemption from retailers’ sales tax on direct 
          purchases of laundering and dry cleaning services pursuant to K.S.A. 79-3606 . . . . . . . . . . . . . . . . . . . . . . . . .     $ ____________________________ 
     D. 	 Sales to other retailers for purposes of resale . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .     $ ____________________________ 
     E. 	 TOTAL (add lines A, B, C, and D and enter the result here and on line 2, Part I above) . . . . . . . . . . . . . . . . . . . .    $ ____________________________ 

PART II – DRY CLEANING SOLVENT FEE (Solvent Distributors only) 
               1.	  Dry cleaning solvent fee (from line C, Schedule II, below) . . . . . . . . . . . . . . . . . . . . . . . . . . . .                                       $
               2.	  Penalty (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                     $
               3.	  Interest (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                    $
               4.	  Credit memorandum (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                               $
               5.		 Total dry cleaning solvent fee, penalty, and interest (add lines 1, 2, and 3 and subtract line 4)                                                        $ 

                                                    Schedule II — Dry Cleaning Solvent Fee 
                                                                                     NUMBER OF  
                               DRY CLEANING SOLVENT                             GALLONS SOLD                                        FEE PER GALLON                                               TOTAL FEE 
     A.   Perchloroethylene or other chlorinated dry cleaning solvents          __________________                         X    $                                              =  $ ________________________ 
     B.   Any nonchlorinated dry cleaning solvents (petroleum based)            __________________                         X  $                                                =  $ ________________________ 
     C.   TOTAL (add lines A and B and enter the result here and on line 1, Part II above) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                      = $ _________________________ 
     TOTAL AMOUNT DUE (add line 8 from Part I and line 5 from Part II) . . . . . . . . . . . . . . . . . . . . . . . . .                                                     $

                     I CERTIFY  THAT    THIS IS A   TRUE, CORRECT              AND COMPLETE RETURN. 
     SIGN 
     HERE           _______________________________________________                                        ________________________                                           ____________________________ 
                                                    Signature 	                                                               Title                                                       Preparer’s Phone No. 
DC-1 Rev.  -198

                                              INSTRUCTIONS FOR COMPLETING THE 
                              ENVIRONMENTAL SURCHARGE AND SOLVENT FEE RETURN DC-1

                  GENERAL INFORMATION                                         LINE 7 —  Enter the amount of a verified  credit memorandum 
                                                                              issued by the Kansas Department of Revenue for an overpayment 
Pre-printed  returns  are  mailed  to  registered  dry  cleaners,             of surcharge fees. The credit memorandum(s) must be enclosed 
laundry retailers, and dry cleaning solvent distributors. The return          with the return.  NOTE:    A  debit  memorandum  (balance  due) 
is due on or before the 25th day of the month following the taxing            must  be  paid  by  separate  check  and  returned  to  the  Kansas 
period end (i.e., March and first quarter returns are due by April            Department of Revenue. 
25th).  The return must be filed even if no services subject 
to the surcharge were rendered or no dry cleaning solvent                     LINE 8 — Add lines 4, 5, and 6 and subtract line 7. Enter the 
was sold during the reporting period.                                         result on line 8. 

LINE-BY-LINE INSTRUCTIONS                                                     PART II (Solvent Distributors Only) 
                                                                              LINE 1 — If you sold or distributed dry cleaning solvents during 
PART I (Retailers Only) 
                                                                              the reporting period, complete “Schedule II—Dry Cleaning Solvent  
LINE 1 — Enter the total sales of all dry cleaning or laundering              Fee” and enter the total on line 1. If no dry cleaning solvents were  
services  made  during  the  reporting  period  (both  taxable  and           distributed during the reporting period, enter “0”. 
non-taxable). DO NOT  include sales tax or the environmental 
surcharge collected in this figure.                                           LINE 2 — If you are filing a late return, multiply line 1 by the 
                                                                              applicable penalty. Information regarding the current and prior 
LINE 2 — If  line  1  includes  any  tax-exempt  sales,  complete             penalty rates can be obtained from our website:   ksrevenue.org 
Schedule  I—Deductions   and  enter  total  on  line  2.  If  all  sales 
reported on line 1 were taxable, enter “0”.                                   LINE 3 —  If you are filing a late return, multiply line 1 b y the 
                                                                              applicable interest. Information regarding the current and prior 
Exempt entities (Line C of Schedule I – Deductions):                          interest rates can be obtained from our website:   ksrevenue.org 
The following entities are exempt from paying the environmental surcharge     LINE 4 —  Enter the amount of a verified credit memorandum          
on  direct  purchase  of  dry  cleaning  or  laundering  services:  The  U.S. issued by the Kansas Department of Revenue for an overpayment 
Government,  its  agencies  and  instrumentalities;  the  state  of  Kansas   of solvent fee(s). The credit memorandum(s) must be enclosed 
and its political subdivisions, (including school districts, counties, and    with the return. NOTE:     A debit memorandum (balance due) must 
cities); elementary and secondary schools, non-commercial educational         be paid by separate check and returned to the Kansas Department  
television and radio stations; nonprofit blood, tissue, and organ banks;      of Revenue. 
nonprofit educational institutions, nonprofit 501(c)(3) historical societies 
and  museums;  nonprofit  hospitals;  nonprofit  501(c)(3)  primary  care     LINE 5 — Add lines 1, 2, and 3 and subtract line 4. Enter the 
clinics and health centers; nonprofit 501(c)(3) religious organizations;      result on line 5. 
and nonprofit 501(c)(3) zoos. 
                                                                              TOTAL  AMOUNT DUE —           Add line 8 from Part I and line 5 
LINE 3 — Subtract line 2 from line 1 and enter the result on line 3.          from Part II and enter the result. This is the total amount due. 
This is your net receipts subject to the environmental surcharge. 
LINE 4 — Multiply the amount on line 3 by 2.5% and enter the                                         FINAL STEPS 
result on line 4. 
                                                                              Make  check  or  money  order  payable  to  “Kansas  Environmental 
LINE 5 — If you are filing a late return, multiply line 4 by the              Surcharge” and write your tax registration number and the  period 
applicable penalty. Penalty and interest is due if the return is              being paid on your remittance. Sign the return and mail with your 
not filed by the due date. Information regarding the current and              remittance. DO NOT  staple your payment to the DC-1 return or 
prior penalty/interest rates can be obtained from our website:                send any other tax payment with this return. 
ksrevenue.org 
                                                                              Contact the Kansas Department of Revenue for questions: KDOR-
LINE 6 — If you are filing a late return, multiply line 4 by the              Miscellaneous  Tax,  PO  B ox 750680 ,  Topeka,  KS  66625-0680; 
applicable interest. Information regarding the current and prior              call 785-368-8222; or email at kdor_miscellaneous.tax@ks.gov        
interest rates can be obtained from our website:   ksrevenue.org