Form Dr 309634 - Local Government User Of Diesel Fuel Tax Return

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DR-309634
Local Government User of
For DOR use only
R. 01/03
Mail To:
Diesel 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 Validation Use Only - Do Not Write or Type in This Space
Return Due By
Late After
Complete Reverse Side of Return First
9.
Diesel Fuel Tax Due: (From Page 2, Part II, Line 7, Columns E plus G plus I) ......................... 9. ________________________
CREDITS
10a. Diesel Fuel Tax Credit: (From Page 2, Part II, Line 8,
Columns D plus F plus H) ...................................................................
10a. _____________________
10b. Gasoline Tax Credit: (From Page 2, Part I, Line 8) ............................ 10b. _____________________
11.
Combined Credits: (Line 10a plus Line 10b) .......................................................................... 11. ________________________
12.
Net Tax Due: (Line 9 minus Line 11) ...................................................................................... 12. ________________________
13.
Penalty: (10% - see instructions) ............................................................................................ 13. ________________________
14.
Interest: (market rate - see instructions) ................................................................................. 14. ________________________
15.
Total Due with Return: ............................................................................................................. 15. ________________________
16.
Amount to be Refunded: .......................................................................................................... 16. ________________________
Check here if you have electronically transmitted funds
Under penalty of perjury, I swear or affirm that this return, including accompanying supporting schedules of receipts and
disbursements, has been examined by me, is true and correct for the period stated, and is made in good faith pursuant
to Chapter 206, Florida Statutes and the regulations issued under authority thereof.
________________________________________________________________
_______________
Signature of Preparer
Title
Date
________________________________________________________________
_______________
Contact Person (Please Print)
Telephone Number

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