Form Wv/mft-508 - West Virginia Importer Report
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1
2Check applicable boxes
□ Address has changed since prior report
WEST VIRGINIA IMPORTER REPORT
WV/MFT-508
□ Amended report
REV 12/06
PO BOX 2991
J
CHARLESTON, WV 25330-299
□ Final Report for closed business
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(304) 558-8623; (304) 558-8624; (304) 558-8625; (304) 558-8626; (304) 558-8627
You must file this report and schedules monthly (even if no activity for the month
YOU MUST KEEP A COPY OF THIS REPORT FOR YOUR RECORDS
(Please Print or Type)
)
Period Ending (Month, Day and Year)
FEIN
NAME
Mailing Address
City
State
Zip Code
Due Date (Month, Day and Year)
Telephone Number
Fax Number
E-mail Address
(
)
(
)
Description
Dyed Diesel &
Aviation
Aviation
Clear Kerosene /
Gasoline
Gasohol
Undyed Diesel
Propane
Dyed Kerosene
Gasoline
Jet Fuel
Other
FOR CALCULATIONS USE INVOICED GALLONS
Gallons @. 11
Gallons @. 11
Gallons @. 11
Gallons @. 11
1.
TAX UNPAID RECEIPTS (Schedule 2)
2.
Diversion into WV (+)
(
Schedule 11)
(Enter gallons @ .2050)
3.
Diversion from WV
(
(-)
Schedule 11A)
(Enter gallons @ .2050)
4.
Diversion into WV (+)
(Schedule 11)
(Enter gallons @ .11)
5.
Diversion from WV
(
(-)
Schedule 11A)
(Enter gallons @ .11)
6.
NET TAXABLE GALLONS @ .2050
(Line 1 plus Line 2 minus Line 3)
7.
NET TAXABLE GALLONS @ .11
(Line 1 plus Line 4 minus line 5)
8.
FLAT RATE TAX DUE
$
$
$
$
(Line 6 multiplied by $0.2050)
9.
VARIABLE RATE TAX DUE
$
$
$
$
$
$
$
$
(Line 7 multiplied by $0.11)
10. Exempt Fuel-Sold or Used for Taxable
Gallons @. 2050
Gallons @. 2050
Gallons @. 2050
ENTER GALLONS
Purpose (on-highway)
(Schedule 5X)
11. Flat Rate Due On Exempt Fuel
$
$
$
(Line 10 multiplied by .2050)
12. TOTAL TAX DUE
$
$
$
$
$
$
$
$
(Add Lines 8, 9 and 11)
GRAND TOTAL TAX DUE
(Add Line 12 for all columns)
13.
$
Administrative Discount
14.
(Line 13 multiplied by 0.001)
Only if timely filed. Maximum $5,000
$
15.
GROSS AMOUNT DUE
(Line 13 minus Line 14)
$
□
□
CREDIT
$
16.
Previous Month $_______________ Period ended __________ (MM/YY)
Exporter return $______________ Period ended_____________ (MM/YY)
□
□
□
$
TOTAL AMOUNT DUE –
17.
IF LINE 15 IS GREATER THAN LINE 16
ACH CREDIT
ACH DEBIT
CHECK ATTACHED
TOTAL REFUND/CREDIT DUE –
□
□
18.
$
DO YOU WANT LINE 18
REFUNDED?
TAKE CREDIT ON NEXT MONTHLY RETURN?
(IF LINE 16 IS GREATER THAN LINE 15)
CERTIFICATION
I certify that I have read this report and all supporting documents and know their contents and that all information on both the report and supporting documents are true, accurate, and complete.
:
Authorized Representative’s Name
(Please Print)
Authorized Representative’s Signature
Date
*O07110401W*
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