Form M-25 - Monthly Report Of Liquid Fuel Sales Reported Without Tax Under The Fuel Tax Law Form - State Of Hawaii - Department Of Taxation

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FORM M-25

STATE OF HAWAII - DEPARTMENT OF TAXATION

License No.

(REV. 1995)

MONTHLY REPORT OF LIQUID FUEL SALES

Date Filed

REPORTED WITHOUT TAX UNDER

This return must be submitted to

the State Tax Collector in your

THE FUEL TAX LAW (CHAPTER 243, HRS)

taxation district on or before the

last day of the month following

the closing date of the monthly

COVERING SALES TO AGENCIES ON MILITARY

accounting period.

OR OTHER RESERVATIONS,

NOT FOR EXCLUSIVE OFFICIAL USE OF THE UNITED STATES

TO BE FILED BY DISTRIBUTORS AND PERSONS SUBJECT TO THE SAME TAXES AS DISTRIBUTORS

Period Covered by Report

NAME

ADDRESS

GENERAL INSTRUCTIONS

1. Every distributor who sells liquid fuel for resale through post exchanges, ship stores, ship service stores, commissaries, filling stations, licensed traders,

and other similar agencies, located on United States military or other reservations, must fill out and file Hawaii Form M-25 monthly.

2. Entries shall be made on Hawaii Form M-25 as indicated by the headings of the various columns and in accordance with the following instructions:

Column 1 - Enter name in full of agency to whom sale was made.

Column 2 - Enter address of agency to whom sale was made.

Column 3, 4 & 5 - Enter opposite the respective names entered in column 1 the total amount of gallons of liquid fuel sold for the period.

I declare, under the penalties set forth in section 231-36, HRS,

that this is a true and correct return, prepared in accordance

with the provisions of the Fuel Tax Law.

SIGNATURE

TITLE:

DATE

COLUMN

— 1 —

— 2 —

— 3 —

— 4 —

— 5 —

NAME

ADDRESS

GALLONS DIESEL OIL

GALLONS AVIATION FUEL

GALLONS GASOLINE

TOTAL ......................................................................................................................................................

FORM M-25