Form Pet 366 - Compressed Natural Gas Tax Return Form - Tennessee Department Of Revenue
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4TENNESSEE DEPARTMENT OF REVENUE
COMPRESSED NATURAL GAS TAX RETURN
Account No.
SSN or FEIN
Filing Period
PET
Beginning:
Location Address
366
Ending:
}
If this is an AMENDED RETURN,
Due Date
please check the box at right
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 Tennes-
see Department of Revenue for the amount
shown on Line 8 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
REMINDERS
1. Read line instructions carefully when completing this return.
free 1-800-342-1003 or (615) 253-0600.
2. Complete all information and schedules.
3. Transfer totals from schedules to appropriate lines.
4. Sign and date your return in the signature box.
TAX COMPUTATION
A gallon equivalent factor of 5.66 pounds per gallon shall be
used when completing this return.
1. Gallons of fuel received during the month ..................................................................................................................
_______________________________
2. Gallons of fuel delivered into licensed vehicles from nontaxable source. (Schedule "A") ...........................................
_______________________________
3. Gallons of fuel used for all purposes other than in a licensed vehicle. (Schedule "B") ...............................................
_______________________________
.
4. Total Tax Due - Multiply Line 2 by
¢ ................................................................................................................
_______________________________
.
5. Enter outstanding credit amount from previous Department of Revenue notice(s) ....................................................
_______________________________
.
If filed LATE, compute penalty at 5% of the tax (Line 10 minus Line 11) for each 1 to 30 DAY PERIOD or portion thereof for which TAX
{
6. Penalty
_______________________________
IS DELINQUENT (Total penalty NOT TO EXCEED 25%.) Minimum penalty is $15 regardless of the amount of tax due or whether there
is any tax due.
.
7. Interest (Line 4 minus Line 5 multiplied by
% per annum on taxes unpaid by the due date) .........................
_______________________________
.
8. TOTAL REMITTANCE AMOUNT (Total of lines 4, 6, and 7; subtract Line 5 if applicable) ........................................
_______________________________
FOR OFFICE
USE ONLY
Under penalties of perjury, I declare that I have examined this claim, and to the best of my knowledge and belief, it is true, correct,
and complete.
Taxpayer's Signature
Date
Title
Tax Preparer Signature
Date
Telephone
Preparer's Address
City
State
ZIP
INTERNET (4-03)
RV-R0007901
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