Alatax Monthly Gasoline / Motor Fuels Tax Return Form

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ALATAX Monthly Gasoline / Motor Fuels Tax Return
Remit To: Tax Division, PO Box 830725, Birmingham, AL 35283-0725
(800) 556-7274
Taxpayer Name & Address:
MAKE CHECK PAYABLE TO: Tax Trust Acct.
Enter your check amount here.
$
__________________________________________
For the Month of:
Jan
Feb
March
April
May
June
July
Aug
Sept.
Oct
Nov
Dec – 2005
th
NOTE: This return must be postmarked by the 20
of the following month to be considered timely and avoid late penalties.
Telephone #:
FEIN or SS#:
Contact Name:__________________________
___________________
__________________________
50-91
Jurisdiction
Jurisdiction
# of Taxable Gallons
Tax
Gross Tax Due
Discount OR
Net Tax Due
Code
Rate
Penalty & Int.
Cities
Anniston – In City
No Discount
9311
2¢
10% Penalty if late
Limits
Anniston – Police
No Discount
9311
1¢
10% Penalty if late
Jurisdiction
Centreville – In City
No Discount
9681
3¢
20% Penalty if Late
Limits
Centreville – In
No Discount
9681
1½¢
20% Penalty if Late
Police Jurisdiction
Clanton – In City
No Discount
9416
1¢
20% Penalty if Late
Limits
No Discount
9712
1¢
Cuba – In City Limits
20% Penalty if Late
Cuba – In Police
No Discount
9712
½¢
20% Penalty if Late
Jurisdiction
No Discount
9346
2¢
Dora – In City Limits
20% Penalty if Late
Greensboro – In City
No Discount
9483
1¢
20% Penalty if Late
Limits
Greensboro – In
No Discount
9483
½¢
20% Penalty if Late
Police Jurisdiction
Hartselle – In City
No Discount
9307
2¢
20% Penalty if Late
Limits
Leesburg- In City
No Discount
9725
2¢
20% Penalty if Late
Limits
Leesburg-In Police
No Discount
9725
1¢
20% Penalty if Late
Jurisdiction
Loxley – In City
No Discount
9330
1¢
Limits
20% Penalty if Late
Loxley – In Police
No Discount
9330
½¢
Jurisdiction
20% Penalty if Late
Ozark – In City
No Discount
9339
2¢
Limits
25% Penalty if Late
Ozark – In Police
No Discount
9339
1¢
Jurisdiction
25% Penalty if Late

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