Liquefied Petroleum Gas And Compressed Natural Gas Dealer And User Monthly Return Form - Iowa Department Of Revenue

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Iowa Department of Revenue
Liquefied Petroleum Gas and Compressed Natural Gas
Dealer and User Monthly Return
81-020a (10/4/01)
LICENSE NUMBER
TAX PERIOD
DUE DATE
Change of address
OFFICE USE ONLY
Check appropriate Box(es)
Mail your return to:
if applicable
Iowa Dept. of Revenue
PO Box 1792
Consolidated Return
Des Moines IA 50306-1792
Complete Schedule L2
Not Using Temperature
Compensated Meters
Amended Return
Attach Corrected Schedules
A
B
(1)
(2)
Computation of LPG and CNG Fuel Tax Due
LPG
CNG
1 Total METER pumped LPG (column A) and CNG (column B) gallons.
Filers must attach Schedule L1. Line 1 must be completed.
2 LPG Exempt Gallonage. List gallonage shown on exemption certificates.
3 Total taxable pumped LPG gallons (column A). Subtract line 2 from line 1.
Per Gallon
Per 100 Cubic Feet
4 FUEL TAX RATE
.20
.16
5 LPG Fuel Tax Due. LPG gallonage on line 3 multipled by tax rate on line 4.
.00
6 CNG Fuel Tax Due. Total CNG reported on line 1 multiplied by tax rate on line 4.
.00
7 Penalty, if applicable. See instructions on reverse side.
8 Interest, if applicable. See instructions on reverse side.
9 Total Amount Due. Column A add lines 5, 7 and 8. Column B add lines 6, 7 and 8.
10 Total Payment(s) made for this tax period. See instructions on reverse side.
11 Balance Due. Subtract line 10 from line 9. See instructions on reverse side.
I certify under penalty for false certification that this is a true and accurate return.
AUTHORIZED SIGNATURE
PRINT AUTHORIZED SIGNATURE
PHONE NUMBER
DATE

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