For tax assistance or to request this document in an alternate format, visit http://dor.wa.gov or call 360-705-6705. Teletype (TTY) users
may call 360-705-6718.
REV 41 0100 (6/25/19)
Renewable Energy System Cost Recovery
Annual Incentive Payment Application
Fiscal year: July 1, 20 - June 30, 20 .
First, contact the utility serving your property to confirm it is participating in this
program and to receive its application procedures for this incentive payment.
Due to your light and power business by August 1.
DOR Account ID:
Light and Power Company Account No:
Applicant Name:
Mailing Address:
City: State: Zip Code:
Telephone No:
Address of Renewable Energy System:
(If different from address above)
City: State: Zip Code:
Date of the letter from the Department of Revenue certifying that your renewable energy system is eligible for the
incentive payment. (Please attach a copy of the letter and certification form.)
Amount of kilowatt-hours generated by the renewable energy system for fiscal year ending June 30, 20 .
Customer-generated power
applicable rates
Base rate (0.15)
multiplied by
applicable factor,
equals incentive
payment rate
Kilowatt-hours
generated
Incentive payment amount
equals incentive payment
rate multiplied by kilowatt-
hours generated
Total may not exceed $5,000
Solar modules manufactured in Washington
Factor: 2.4 (two and four-tenths)
$0.36
Stirling converter manufactured in Washington
Factor: 2.4 (two and four-tenths)
$0.36
Solar or wind generating equipment with an
inverter manufactured in Washington
Factor: 1.2 (one and two-tenths)
$0.18
Both solar modules and inverter
manufactured in Washington
Factor: (2.4 + 1.2) = 3.6 (three and six-tenths)
$0.54
Anaerobic digester or other solar equipment
or wind generator equipped with blades
manufactured in Washington
Factor: 1.0 (one)
$0.15
Wind generator equipped with both blades
and inverter manufactured in Washington
Factor: (1.0 + 1.2) = 2.2 (two and two-tenths)
$0.33
All other electricity produced by wind
Factor: 0.8 (eight-tenths)
$0.12
I acknowledge that my renewable energy system:
Has been operable throughout the fiscal period, from to .
(date) (date)
Will have reasonable access for my light and power business, allowing them to read my electric production
meter in order to calculate the kilowatt-hours generated during the prior fiscal year beginning July 1 and ending
on June 30.
I understand that this information is provided to the Department of Revenue in determining whether the light and power
business correctly calculates its credit allowed for customer incentive payments and that my statements are true,
complete, and correct to the best of my knowledge and belief under penalty of perjury.
Signature:
Date:
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