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NEW OWNERS                                   KANSAS DEPARTMENT OF REVENUE                                                                                690018
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. 12-21



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                                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 
Pre-printed returns are mailed to registered dry cleaners,              an  overpayment  of  surcharge  fees.  The  credit 
laundry  retailers,  and  dry  cleaning  solvent  distributors.         memorandum(s) must be enclosed with the return. 
The return is due on or before the 25th day of the month                NOTE:    A debit memorandum (balance due) must 
following the taxing period end (i.e., March and first quarter          be  paid  by  separate  check  and  returned  to  the 
returns are due by April 25th). The return must be filed                Kansas Department of Revenue.
even if no services  subject to the surcharge were 
rendered or no dry cleaning solvent was sold during                     LINE 8 - Add lines 4, 5, and 6 and subtract line 7. Enter the 
                                                                        result on line 8.
the reporting period.
LINE-BY-LINE INSTRUCTIONS                                               PART II (Solvent Distributors Only)
                                                                        LINE 1 - If  you  sold  or  distributed  dry  cleaning  solvents 
PART I (Retailers Only)                                                 during  the  reporting  period,  complete  “Schedule 
LINE 1 - Enter the total sales of all dry cleaning or laundering        II—Dry  Cleaning  Solvent  Fee”  and  enter  the 
services  made  during  the  reporting  period  (both                   total  on  line  1.  If  no  dry  cleaning  solvents  were 
taxable and non-taxable).       DO NOT   include sales                  distributed during the reporting period, enter “0”.
tax  or  the  environmental  surcharge  collected  in                   LINE 2 - If you are filing a late return, multiply line 1 by 
this figure.                                                            the  applicable  penalty.  Information  regarding  the 
LINE 2 - If line 1 includes any tax-exempt sales, complete              current  and  prior  penalty  rates  can  be  obtained 
Schedule I—Deductions and enter total on line 2. If                     from our website: ksrevenue.gov
all sales reported on line 1 were taxable, enter “0”.                   LINE 3 - If you are filing a late return, multiply line 1 by 
Exempt entities (Line C of Schedule I – Deductions):                    the applicable interest. Information regarding the 
                                                                        current  and  prior  interest  rates  can  be  obtained 
The  following  entities  are  exempt  from  paying  the 
                                                                        from our website:
environmental  surcharge  on  direct  purchase  of  dry  cleaning                                ksrevenue.gov
or  laundering  services:  The  U.S.  Government,  its  agencies        LINE 4 - Enter the amount of a verified credit memorandum 
and  instrumentalities;  the  state  of  Kansas  and  its  political    issued  by  the  Kansas  Department  of  Revenue 
subdivisions,  (including  school  districts,  counties,  and  cities); for  an  overpayment  of  solvent  fee(s).  The  credit 
elementary and secondary schools, non-commercial educational            memorandum(s) must be enclosed with the return. 
television and radio stations; nonprofit blood, tissue, and organ       NOTE:    A debit memorandum (balance due) must 
banks;  nonprofit  educational  institutions,  nonprofit  501(c)(3)     be  paid  by  separate  check  and  returned  to  the 
historical societies and museums; nonprofit hospitals; nonprofit        Kansas Department of Revenue.
501(c)(3)  primary  care  clinics  and  health  centers;  nonprofit              Add lines 1, 2, and 3 and subtract line 4. Enter the 
                                                                        LINE 5 - 
501(c)(3) religious organizations; and nonprofit 501(c)(3) zoos.        result on line 5.
LINE 3 - Subtract line 2 from line 1 and enter the result 
                                                                        TOTAL AMOUNT DUE -       Add line 8 from Part I and line 5 
on line 3. This is your net receipts subject to the 
                                                                        from Part II and enter the result. This is the total 
environmental surcharge.
                                                                        amount due.
LINE 4 - Multiply the amount on line 3 by 2.5% and enter 
         the result on line 4.                                                     FINAL STEPS
LINE 5 - If you are filing a late return, multiply line 4 by the        Make  check  or  money  order  payable  to  “Kansas 
         applicable penalty. Penalty and interest is due if             Environmental Surcharge” and write your tax registration 
         the return is not filed by the due date. Information           number and the period being paid on your remittance. Sign 
         regarding  the  current  and  prior  penalty/interest          the return and mail with your remittance. DO NOT staple 
         rates  can  be  obtained  from  our  website:                  your  payment  to  the  DC-1  return  or  send  any  other  tax 
         ksrevenue.gov                                                  payment with this return.
LINE 6 - If you are filing a late return, multiply line 4 by            Contact the Kansas Department of Revenue for questions: 
         the applicable interest. Information regarding the             KDOR-Miscellaneous  Tax,  PO  Box  750680,  Topeka, 
         current  and  prior  interest  rates  can  be  obtained        KS  66625-0680;  call  785-368-8222;  or  email  at kdor_
         from our website: ksrevenue.gov                                miscellaneous.tax@ks.gov






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