WV/BOT-300F
WEST VIRGINIA BUSINESS AND OCCUPATION TAX
REV 01/07
SYNTHETIC FUEL MANUFACTURED
If business was sold or discontinued give date and name and address of new owner
OR PRODUCED FROM COAL
1. TONS OF SYNTHETIC FUEL SOLD
2. RATE OF TAX = $ .50 PER TON
PERIOD ENDING
DUE DATE
3. TOTAL TAX DUE (lINE 1 X LINE 2)
YOUR ACCOUNT IDENTIFICATION NUMBER
*B18010701W*
SIGNATURE OF TAXPAYER OR PREPARER
DATE