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Form Ivg-1 - Indiana Gasoline Inventory Tax Voucher Form - Indiana Department Of Revenue

Line Instructions for completing Form IVG-1

Use this Voucher to determine the amount owed on your stored gasoline held for resale as of January 1, 2003, at

12:01am.

If you currently file a consolidated Sales and Use Tax return, you may file a consolidated IVG-1.

Line 1: Enter the total amount of gallons in transit or stored in above ground and underground storage x .03 as of

January 1, 2003, at 12:01a.m.

Line 2: If your voucher is filed after the January 30, 2003, due date, you will owe penalty and interest. Penalty is 10%

of the amount due (line 1 ) or $5.00, whichever is greater. Interest is computed from the due date of the

voucher to the date payment is made. Interest is not computed on the penalty. Interest should be figured on

the amount on line 1. The interest rate for 2003 is 6%

Line 3: Please pay this amount. Do not send cash. Make your check payable to the Indiana Department

of Revenue. Mail to address shown on front of voucher.

Note:

You must file this voucher even if your location does not sell fuel. Check the appropriate box on the voucher

and return the voucher to the Department with a postmark date no later than January 30, 2003.

Form Back:

Please complete the back of the voucher listing the name, address and Federal Identification

Number (FID) of each gasoline supplier. List up to three (3) primary gasoline suppliers.

Indiana Gasoline Inventory Tax Voucher

Form IVG-1

Do not use this space.

State Form 51066

(R/ 9-02)

This location does not sell fuel.

Business Name

Address (City, State, Zip)

Gallons in transit or stored X .03 (as of

1-1-2003 at 12:01 a.m.) .................................... 1

Taxpayer ID Number

Location Number

If late, penalty is Greater of $5 or 10% of

line 1, plus interest ........................................ 2

Phone # (

)

Date

INDIANA DEPARTMENT OF REVENUE

Total Amount Due (Add lines 1 and 2) ......... 3

P.O. BOX 6194

INDIANAPOLIS, IN 46206-6194

Pay this amount. Do not send cash.

Authorized

Signature

Complete the back side of this form listing your gasoline suppliers.

I declare under penalties of perjury that this is a true, correct and complete voucher.

Form Ivg-1 - Indiana Gasoline Inventory Tax Voucher Form - Indiana Department Of Revenue

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