State Form Sf-Ivp - Importer Verification Payment Voucher

ADVERTISEMENT

SF-IVP
Indiana Department of Revenue
Importer Verification
State Form 46635
(R2/6-05)
Payment Voucher
Payment is due within 3 business days after the date of the transaction.
Name of License Holder (as indicated on license)
License Number
Mailing Address
FEIN/SSN
City or Town
State
Zip Code
Business Telephone Number
Import Verification Number Date Verification Requested
Transporter License Number Bill of Lading Number
Bill of Lading Date
V-
A person desiring to import special fuel to an Indiana destination, in a transport vehicle having a capacity of 5,400 gallons or more,
who does not enter into an agreement to prepay Indiana Special Fuel Tax to a Supplier or Permissive Supplier must do the following:
a)
Obtain a valid Importer License;
b) Obtain an Import Verification Number no earlier than twenty-four (24) hours before entering the state with each import by
calling (317) 615-2630;
c)
Display a proper Import Verification Number on the shipping document; and
d) File this voucher with your payment within 3 business days after the earlier of:
(1) the date the valid Import Verification Number was assigned, or
(2) the time the fuel entered into Indiana.
A separate Import Verification Payment Voucher must be sent for each Import Verification Number obtained.
1. Total Gallons of Taxable Special Fuel Imported into Indiana
1.
2. Tax Due (Multiply Line 1 by $0.16)
2.
$
.
3. Collection Allowance (Multiply Line 2 x .016)
3.
$
(If return is filed or tax paid after the due date, enter zero)
4. Special Fuel Tax Due (Line 2 minus Line 3)
4.
$
5. Oil inspection fees due (Multiply Line 1 by $0.01)
5.
$
6. Total Special Fuel Tax and Oil Inspection Fee (Line 4 plus Line 5)
6.
$
7. Penalty (Penalty must be added if report is filed after the due date - 10%
of Line 6 tax due or $5.00, whichever is greater.)
7.
$
8. Interest (Interest must be added if the tax is paid after the due date,
8.
$
call the Department for daily interest rate)
9. Total Amount Due (Add Lines 6, 7, and 8)
9.
$
+
-
10. Adjustment - Schedule E-1 Must Be Attached and is Subject to Approval.
Circle
10. $
For Department Use Only
11. Adjusted Amount Due (Line 9 + or - Line 10)
11. $
Check
Check
Amount:
Number:
Make check payable to Indiana Department of Revenue and mail with return to:
P.O. Box 6080, Indianapolis, Indiana 46206-6080
(Please include your Importer's License Number on checks.)
Under penalty of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best
of my knowledge and belief it is true, correct, and complete. I further declare that complete and proper records are on file at the address
indicated above for all fuel reported on this return.
Taxpayer or Authorized Agent
Typed or Printed Name
Title
Date Signed
Telephone Number
Please Check Box If Last Filing
Date Business Closed
/
/

ADVERTISEMENT

00 votes

Related Articles

Related forms

Related Categories

Parent category: Financial
Go
Page of 2