Form Dr 309632 - Wholesaler/importer Fuel Tax Return
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15DR-309632
Wholesaler/Importer
For DOR use only
R. 01/03
Mail To:
Fuel Tax Return
Florida Department of Revenue
Page 1
/
/
5050 W. Tennessee Street
Tallahassee, Florida 32399-0165
❑
Check here if amending return
FEIN
Collection Period Ending
RDS Validatin Only - Do Not Write or Type in This Space
Return Due By
Late After
Complete Reverse Side of Return First
24.
Combined Gasoline, Diesel, and Aviation Fuel Tax Due: (From Page 2, Line 24) .................................. 24. _____________________
CREDITS
25.
Ultimate Vendor Credits: (From Schedule 12) .............................................. 25. __________________
26.
Credit Memos Issued by DOR: ...................................................................... 26. __________________
TOTAL DUE WITH RETURN CALCULATION
27.
Tax Due With Return: (Line 24 minus Lines 25 and 26) ........................................................................... 27. _____________________
28.
Penalty: (10% - see instructions) ............................................................................................................. 28. _____________________
29.
Interest: (market rate - see instructions) .................................................................................................. 29. _____________________
30.
Total Due with Return: (Line 27 plus Line 28 plus Line 29) ..................................................................... 30. _____________________
❑
Check here if you have electronically transmitted funds
Under penalties of perjury, I swear or affirm that this return, including any accompanying schedules and statements, has
been examined by me and it is true, correct and complete for the collection period stated.
_____________________________________________________________________
__________________
Signature of Officer/Owner
Title
Date
_____________________________________________________________________
__________________
Name of Preparer (Print)
Signature of Preparer
Telephone Number
FEIN
Date
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