Form Pet 355 - Dealer'S Liquified Gas Tax Return Form - Tennessee Department Of Revenue
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1
2TENNESSEE DEPARTMENT OF REVENUE
DEALER'S LIQUIFIED GAS TAX RETURN
Filing Period
Account No.
SSN
PET
Beginning:
or
Location Address
355
FEIN
Ending:
Due Date
Returns must be postmarked by the due
date to avoid the assessment of penalty and
interest. Returns must be filed even if no tax
is due.
Make your check payable to the Tennessee
Department of Revenue for the amount shown
on Line 9 and mail to:
Tennessee Department of Revenue
Andrew Jackson State Office Bldg.
500 Deaderick Street
Nashville, TN 37242
For assistance, you may call in-state toll free
1-800-342-1003 or (615) 253-0600.
REMINDERS
1. Maintain adequate records to support this return.
IF AN AMENDED
RETURN
2. If assistance is required to complete this return, please refer to the phone
CHECK HERE
numbers listed above or on the back.
3. Sign and date this return in the signature box below.
ROUND TO THE NEAREST GALLON
TAX COMPUTATION
1. Total gallons of product available for sale (Include prior quarter's ending inventory and all receipts
of liquified gas during reporting period) .................................................................................................................. (1)
_______________________________
2. Total gallons sold to holders of Tennessee liquified gas decals during reporting quarter ..................................... (2)
_______________________________
3. Total gallons sold to vehicles on which the Tennessee liquified gas tax must be collected and remitted ............. (3)
_______________________________
4. Total gallons sold for purposes other than listed above .......................................................................................... (4)
_______________________________
.
5. Tax Due (Multiply Line 3 by
¢ per gallon) ........................................................................................................ (5)
_______________________________
.
6. Credits: Enter outstanding credit amount from previous Department of Revenue notice(s) ................................. (6)
_______________________________
.
If filed late, penalty is computed at 5% of the tax (Line 5 minus Line 6) for each 30-day period or portion thereof that the return
{
7. Penalty
............. (7)
_______________________________
is delinquent. Maximum penalty is 25% of the tax due; minimum penalty is $15 regardless of the tax amount due or whether
any tax is due.
.
If filed late, compute interest at
% per annum on the tax (Line 5 minus Line 6)
8. Interest -
.............. (8)
_______________________________
.
from the due date to the date of payment
.
9. Total Remittance Amount (Add Lines 5, 7 and 8; subtract Line 6 if applicable) .................................................... (9)
_______________________________
Under penalties of perjury, I declare that I have examined this return, and to the best of my
knowledge and belief, it is true, correct, and complete.
FOR OFFICE
USE ONLY
Taxpayer's Signature
Date
Date
Signature of Preparer other than Taxpayer
Phone Number
Tax Preparer's Address
INTERNET (4-03)
RV-R0004301
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