Form Dr 309633 - Mass Transit System Provider Fuel Tax Return
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5DR-309633
Mass Transit System
For DOR use only
R. 01/03
Mail To:
Provider Fuel Tax Return
Page 1
Florida Department of Revenue
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5050 W. Tennessee Street
Tallahassee, Florida 32399-0165
❑
Check here if amending return
FEIN
Collection Period Ending
RDS Validation Only - Do Not Write or Type in This Space
Return Due By
Late After
Complete Reverse Side Of Return First
9.
Diesel Fuel Tax Due: (From Part II, Line 7, Column C) ......................................................... 9. _________________________
CREDITS
10a.
Diesel Fuel Tax Credit: (From Part II, Line 8, Column B) ................. 10a. ______________________
10b.
Gasoline Tax Credit: (From Part I, Line 7, Column A) ...................... 10b. ______________________
11.
Combined Credits: (Line 10a plus Line 10b) ........................................................................ 11. ________________________
12.
Net Tax Due: (Line 9 minus Line 11) .................................................................................... 12. ________________________
13.
Penalty: (10% - see instructions) ......................................................................................... 13. ________________________
14.
Interest: (market rate - see instructions) .............................................................................. 14. ________________________
15.
Total Due with Return: .......................................................................................................... 15. ________________________
16.
Amount to be Refunded: ....................................................................................................... 16. ________________________
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Check here if you have electronically transmitted funds
Under penalty of perjury, I swear or affirm that this return, including accompanying supporting schedules of receipts
and disbursements, has been examined by me, is true and correct for the period stated, and is made in good faith
pursuant to Chapter 206, Florida Statutes and the regulations issued under authority thereof.
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Signature of Preparer
Title
Date
_______________________________________________________________
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Contact Person (Please Print)
Telephone Number
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