Form Wv/mft-514 - West Virginia Producer Report
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1
2WV/MFT-514
WEST VIRGINIA PRODUCER REPORT
REV 03/08
PO BOX 2991
CHARLESTON, WV 25330-2991
H
(304) 558-8623; (304) 558-8624; (304) 558-8625; (304) 558-8626; (304) 558-8627
The Producer of Motor Fuel That Is Taxable Under WV Code §11-14C Is Liable for the Tax
(A return is not required if there is no reportable activity)
Name and address
FEIN/SOCIAL SECURITY NUMBER
Period Ending (MM-DD-YYYY)
Due Date (MM-DD-YYYY)
Telephone Number
CHECK APPLICABLE BOXES:
(
)
Address changed since prior report
Fax Number
Amended return
(
)
Final report for closed business
E-mail Address
CALCULATION OF TAX
1
TOTAL GALLONS – Undyed Product Produced
(From Line 3, Worksheet A)
TOTAL GALLONS – Undyed Product Produced used off-highway
2
3
TAXABLE UNDYED GALLONS (
)
Line 1 minus Line 2
4
TOTAL GALLONS – Dyed Product Produced (
)
From Line 3, Worksheet B
5
TAX DUE – Undyed Product Produced
)
(Multiply Line 3 by $0.322
6
TAX DUE – Dyed Product Produced (
)
Multiply Line 4 by $0.117
7
TOTAL TAX DUE
(
)
Add Lines 5 and 6
If Amended Return – (
)
8
Enter amount paid on original return
9
NET TAX DUE
(
)
If Line 7 is greater than Line 8, subtract Line 8 from Line 7, otherwise enter -0-
10
NET REFUND DUE (
)
If Line 8 is greater than Line 7, subtract Line 7 from Line 8, otherwise enter -0-
CERTIFICATION
I certify that I have read this report and all supporting documents and know their contents and that all information on both the report and supporting documents are
true, accurate, and complete.
Authorized Representative’s Name (Please Print)
Title
Authorized Representative’s Signature
Date
Telephone Number
Fax Number
E-mail Address
(
)
(
)
*O03200801A*
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