Form Gt-5 - Gasoline Distributor Tax Return 2012
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1
2GAS
Maine Revenue Services
00
Gasoline Distributor Tax Return
*1208000*
Registration No.
Period Begin
Due Date
Period End
1. Entity Information
2.
OUT OF BUSINESS?
Date closed:
3.
OWNERSHIP OR NAME CHANGE?
Date
Explanation
4.
SOLD? Date
ADDRESS CHANGE? Make corrections above and check here
Do Not Use Red Ink!
Receipts
,
,
Beginning Inventory
1.
,
,
Gallons Received - Tax Paid
Sch 1
2.
,
,
Gallons Received - Tax Unpaid
Sch 2
3.
,
,
Gallons Imported - Direct to Customer
Sch 3
4.
,
,
Gallons Imported - Bulk Storage
Sch 4
5.
,
,
Total Receipts (total lines 2 through 5)
6.
,
,
Available Gallons (line 1 plus line 6)
7.
,
,
Ending Inventory
8.
,
,
Accountable Gallons (line 7 minus line 8)
9.
Sales
,
,
Total Gallons Sold and Used
10.
,
,
Exports
Sch 7
11.
,
,
Sales to Licensed Distributors
Sch 6
12.
,
,
Bulk Sales to United States Government
Sch 8
13.
,
,
Bulk Sales to Agencies or Political Subs of this State
Sch 9
14.
,
,
Jet Fuel for International Flights
Sch 10
15.
,
,
Total Exempt Sales - (add lines 11 though 15)
16.
,
,
Taxable Gallons - (line 10 minus line 16)
17.
For assistance in completing this form, call (207) 624-9609
GT5 Revised 7/2012
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