Form M-20a - Monthly Return Of Liquid Fuel Tax (State And County) And Environmental Response Tax Form - State Of Hawaii - Department Of Taxation

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STATE OF HAWAII - DEPARTMENT OF TAXATION
FORM M-20A
MONTHLY RETURN OF LIQUID FUEL TAX (STATE AND COUNTY)
(REV. 2006)
AND ENVIRONMENTAL RESPONSE TAX
TO BE FILED
BY DISTRIBUTOR
(Chapter 243, HRS)
£
£
£
IF APPLICABLE, CHECK BOX:
INITIAL RETURN
AMENDED RETURN
FINAL RETURN
Name of Distributor
Permit Number
NOTE: This return with
Please
payment
must
be
Print
submitted
to
the
Business address (Number and Street)
FEIN Number
Department of Taxation
or
on or before the last day
Type
of the month following
City, State, ZIP code
Period Covered
the close of the filing
period.
PART I — COMPUTATION OF FUEL AND ENVIRONMENTAL RESPONSE TAX
(a)
(b)
(c)
(d)
(e) Add cols. a to d
LIQUID FUEL CLASSIFICATION
CITY & COUNTY
COUNTY OF MAUI
COUNTY OF
COUNTY OF
TOTAL OF ALL
OF HONOLULU
(Use Part II Summary)
HAWAII
KAUAI
COUNTIES
On Highway Diesel Oil and Liquid Fuel
1. Diesel - On Hwy.
Gals.
2. Gasoline & Other Liquid Fuel:
a. Premium
Gals.
b. Regular
Gals.
c. Unleaded
Gals.
d. Others (specify):
Gals.
Gals.
3. Total (2a through 2d)
Gals.
4. Total (Add lines 1 and 3) Gals.
b
a
e
5.
Tax Rate
32.5¢
34¢
/32¢
24.8¢
29¢
6.
Total tax for On Highway Diesel Oil and Liquid Fuel
On Highway Alternative Fuel
7. LPG - On Hwy.
Gals.
c
c
c
c
8.
Tax Rate
10.6¢
9.5¢
8.1¢
9.5¢
9. Total tax for On Highway LPG
(see
10.
Gals.
instructions)
11. Tax Rate (see instructions)
12.
Total tax for other On Highway Alternative Fuel
Off Highway Liquid Fuel
13. Aviation
Gals.
14. Diesel - Off Hwy.
Gals.
15. Total (Add lines 13 and 14) Gals.
16.
Tax Rate
17.
Total tax for Off Highway Aviation and Diesel Oil
18. Grand Total Gallons - Add lines 4, 7, 10, and 15
19. Total Fuel Tax - Add lines 6, 9, 12, and 17
ENVIRONMENTAL RESPONSE TAX
20. Petroleum Products (Number of barrels)
21. Tax @ 5 cents per barrel
22. Total Environmental Response Tax
23. TOTAL TAXES DUE —
Add Lines 19e and 22e
Complete Parts II, III, and IV on pages 2 and 3
DECLARATION
I declare, under the penalties set forth in section 231-36, HRS, that this is a true, correct, and complete return, prepared in accordance with the provisions of chapter 243, HRS, the
Fuel Tax Law, and chapter 18-243, HAR.
SIGNATURE
TITLE
DATE
a
Effective July 1, 2003, pursuant to Maui County Resolution No. 03-65.
b
Pursuant to City and County of Honolulu Resolution No. 02-55.
c
Effective July 1, 2004, pursuant to Act 96, SLH 2004.
e
Effective July 1, 2006, pursuant to Maui County Resolution No. 06-44.
FORM M-20A

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