Form Dr 309635 - Blender/wholesaler Of Alternative Fuel Tax Return

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DR-309635
Blender/Wholesaler of
For DOR use only
R. 01/03
Mail To:
Alternative 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 Only - Do Not Write or Type in This Space
Return Due By
Late After
Complete Reverse Side of Return First
24.
Combined Gasoline, Diesel, Aviation and Local Option 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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