Form ECY 070-487 Small Business Extreme Hardship Fee Reduction Form - Washington

Form ECY070-487 is a Washington State Department of Ecology form also known as the "Small Business Extreme Hardship Fee Reduction Form". The latest edition of the form was released in January 1, 2019 and is available for digital filing.

Download a PDF version of the Form ECY070-487 down below or find it on Washington State Department of Ecology Forms website.

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Air Quality
Registration Program Fee Reduction Application
Small Business Extreme Hardship
Small Business Extreme Hardship Fee Reduction Form
The small business extreme hardship fee reduction is available to a registration program source
with a net profit of $12,000 or less. If you meet the qualifications in this form, a nswer all the
questions on both pages, sign and date the form, and submit it to Ecology’s Cashiering Unit in
Olympia. You must include the required tax documentation and half of your fee. Your application
will be invalid without the required tax documentation so your original invoice applies. Ecology
will notify you if you do not qualify for this reduction and full payment is due within 30 days of
the notice. You must reapply each year for this fee reduction.
Business Name
Air Quality Program Identification Number
Business Address
Business City
State
Zip code
Contact Name
Mailing Address
Mailing City
State
Zip code
Telephone Number
E-mail address
Eligibility Requirements
To qualify, a business must meet all of the following criteria. Check each as they apply.
You are a registration program source.
You are owned and operated independently from all other business (not a subsidiary of a
parent company).
Enter your annual net profit from your most recent income tax return. To be eligible, your
net profit must be $12,000 or less. Annual net profit: ____________________________
Check the tier fee that applies to you. Your new fee will be half the amount of your
assessed tier. For fee amounts, see
WAC
173-455-040.
Tier 1
Tier 2
Tier 3
Tier 4
ECY 070-487 (Rev. 1/19)
Page 1 of 2
Air Quality
Registration Program Fee Reduction Application
Small Business Extreme Hardship
Small Business Extreme Hardship Fee Reduction Form
The small business extreme hardship fee reduction is available to a registration program source
with a net profit of $12,000 or less. If you meet the qualifications in this form, a nswer all the
questions on both pages, sign and date the form, and submit it to Ecology’s Cashiering Unit in
Olympia. You must include the required tax documentation and half of your fee. Your application
will be invalid without the required tax documentation so your original invoice applies. Ecology
will notify you if you do not qualify for this reduction and full payment is due within 30 days of
the notice. You must reapply each year for this fee reduction.
Business Name
Air Quality Program Identification Number
Business Address
Business City
State
Zip code
Contact Name
Mailing Address
Mailing City
State
Zip code
Telephone Number
E-mail address
Eligibility Requirements
To qualify, a business must meet all of the following criteria. Check each as they apply.
You are a registration program source.
You are owned and operated independently from all other business (not a subsidiary of a
parent company).
Enter your annual net profit from your most recent income tax return. To be eligible, your
net profit must be $12,000 or less. Annual net profit: ____________________________
Check the tier fee that applies to you. Your new fee will be half the amount of your
assessed tier. For fee amounts, see
WAC
173-455-040.
Tier 1
Tier 2
Tier 3
Tier 4
ECY 070-487 (Rev. 1/19)
Page 1 of 2
Air Quality
Registration Program Fee Reduction Application
Small Business Extreme Hardship
Attach tax documentation of the amount of net profit for the calendar year by providing a
copy of one of the following:
Most Recent Tax Form
Line
Schedule C Form 1040 Profit or Loss From
Line 31. Net profit or loss
Business (Sole Proprietorship)
Form 1065 U.S. Return of Partnership Income
Line 22. Ordinary business income (loss)
Form 1120 U.S. Corporation Income Tax Return
Line 30. Taxable income
Check the box that applies.
This person must sign this form
Sole proprietorship
Proprietor
Partnership
Authorized partner
Limited Liability Company (LLC)
Member
Corporation
Authorized corporate officer
I certify that all information contained in this application and in supporting documents is true and correct.
I understand that omissions or misrepresentations will result in denial of the fee reduction application and
revocation of previously granted fee reductions.
Print Name
Title
Signature
Date
Sign this form and mail it along with supporting tax documentation, your check and the bottom
portion of your Ecology invoice to:
Department of Ecology – Cashiering Unit
For Fiscal Office Use Only:
P.O. Box 47611, Olympia, WA 98504-7611
216-AIREG-02-99-000800
PLEASE INCLUDE THE INVOICE NUMBER ON YOUR CHECK.
Check the box for the location of your business.
Contact
Chelan, Douglas, Kittitas, Klickitat, or Okanogan County
Shawn Nolph
(509) 454-7845
CRO
Ecology Central Regional Office
shawn.nolph@ecy.wa.gov
Adams, Asotin, Columbia, Ferry, Franklin, Garfield, Grant, Lincoln,
Gail Wright
Pend Oreille, Stevens, Walla Walla or Whitman County
(509) 329-3487
ERO
gail.wright@ecy.wa.gov
Ecology Eastern Regional Office
If you need this document in a format for the visually impaired, call the Air Quality Program at
360-407-6800. Persons with hearing loss can call 711 for Washington Relay Service. Persons with
a speech disability can call 877-833-6341.
ECY 070-487 (Rev. 1/19)
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