ANNUAL TIER II FACILITY FILING FEE WORKSHEET - dhsem wv: Fill out & sign online

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Click ‘Get Form’ to open the ANNUAL TIER II FACILITY FILING FEE WORKSHEET in the editor.
Begin by filling out the Facility Information section. Enter your Company Name, Facility Name, Address, City, State, ZIP Code, County, Contact Person, Telephone, and E-Mail. Ensure all details are accurate for smooth processing.
In the Fee Calculation section, start with Line A by entering the Base Tier II Filing Fee of $25.00.
For Line B, input the total number of storage facilities for which you are submitting Tier II information.
Proceed to Line C by subtracting 35 from the number entered in Line B. If this results in a negative number, enter 0.
Multiply the number on Line C by $10 and enter this amount on Line D.
Add the amounts from Line A and Line D together and write the total on Line E.
If your payment is postmarked after March 31, remember to calculate a 20% late fee and enter it on Line F.
Finally, calculate your total filing fee and enter it on Line G. Ensure that this worksheet is submitted with your Tier II information by March 1.

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