Form 572 - Supplier And Permissive Supplier'S Monthly Tax Report

Download a blank fillable Form 572 - Supplier And Permissive Supplier'S Monthly Tax Report in PDF format just by clicking the "DOWNLOAD PDF" button.

Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.

Complete Form 572 - Supplier And Permissive Supplier'S Monthly Tax Report with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.

Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.

ADVERTISEMENT

Print Form
Reset Form
Document Locator Number
Form
Missouri Department of Revenue
572
Supplier and Permissive Supplier’s Monthly Tax Report
Company Name
Month and Year
Amended Report
Additional Report
r
r
__ __ /__ __ __ __
Street Address
P.O. Box
License Number
Federal Employer Identification Number
City
State
ZIP Code
Telephone Number
Missouri Tax Identification Number
(__ __ __) __ __ __-__ __ __ __
Round All Calculations to Whole Gallons or Whole Dollars
Liquefied
100% Ethyl
Aviation
Clear Diesel &
Dyed Diesel &
Motor Fuel Tax Due
Gasoline
Natural Gas
Gasohol
Alcohol
Gasoline
Clear Kerosene
Kerosene
(LNG)
1. Gross taxable gallons (From worksheet,
Line 14W) ................................................
2. Tax adjustments (From worksheet,
Line 4W) ...................................................
3. Taxable gallons (Line 1 minus Line 2) ......
4. Allowance (Calculate Line 3 times (X)
3%
3%
3%
3%
2%
2%
2%
percentage in each column ......................
5. Net gallons subject to tax (Line 3 minus
Line 4) .......................................................
Tax Rates
x $.17
x $.17
x $.17
x $.09
x $.17
x $.05
x $.17
6. Tax Due - (Line 5 times tax rate indicated
above) .......................................................
00
00
00
00
00
00
7. Supplier credit (Line 6 x $.001) (If return
is filed late or tax is not paid by the due
date, enter 0) ............................................
00
00
00
00
00
00
8. Tax due (Line 6 minus Line 7). ...................
00
00
00
00
00
00
9. Credit authorization (Attach copy of letter) .
00
00
00
00
00
00
10. Total tax due (Line 8 minus Line 9) ............
00
00
00
00
00
00
11. Gallons subject to inspection fee (From worksheet, Lines
21. Total fuel tax due (Line 10, Columns at the
00
8W plus 14W minus Line 4A and Line 15W) ......................
applicable rate) .................................................
12. Inspection fee due $0.035 per 50 gallons) .........................
00
22. Total aviation gasoline tax due (Line 10,
Column at $.09 rate) ........................................
00
13. Credit authorization (Attach copy of letter) .........................
00
23. Total inspection fee due (Line 14) ...................
00
14. Total inspection fee due (Line 12 minus Line 13) ...............
00
24. Total transport load fee due (Line 20) ..............
00
25. Total taxes and fees due (Lines 21, 22, 23, and
15. Gallons subject to transport load fee (Line 11 above) ........
24) ...................................................................
00
16. Gallons sold to railroad corporations and airline
26. Penalty (5% per month up to 25% of Line 25) ..
00
companies (total from attached Schedule 10) ....................
27. Interest for late payment (Compute using total
17. Total gallons subject to transport load fee (Line 15 minus
on Line 25) (See Line 27 of instructions) .........
00
Line 16) ......................................................................................
28. Total taxes, fees, penalty and interest due
18. Transport load fee (Line 17 divided by 8,000 gals. x
(Lines 25, 26, and 27) ......................................
$20.00) ................................................................................
00
00
29. Pool bond collections (From
Form
4759) .........
19. Credit authorization (Attach copy of letter) .........................
00
00
30. Total amount remitted (Line 28 plus Line 29) ...
20. Total transport load fee due (Line 22 minus Line 23) .........
00
00
If you pay by check, you authorize the Department of Revenue to process the check electronically. Any check returned unpaid may be presented again electronically.
Under penalties of perjury, I declare that the above information and any attached supplement is true, complete, and correct.
Print Name
Signature
Title
Date (MM/DD/YYYY)
__ __ /__ __ /__ __ __ __

ADVERTISEMENT

00 votes

Related Articles

Related forms

Related Categories

Parent category: Financial
Go
Page of 2