Gasoline Tax - Municipality Of Robertsdale printable pdf download

MUNICIPALITY OF ROBERTSDALE, ALABAMA

GASOLINE TAX

ACCOUNT NUMBER ________________________

MAIL THIS RETURN WITH REMITTANCE TO:

REPORTING PERIOD ___________________________________

(This return only for the business shown below).

Total Amount Enclosed

Has a change occurred in Taxpayer Name, Trade Name, Mailing Address, Business Address, or Number of Outlets?

____Yes ____No

Is this a final return? ____Yes ____No

If yes, attach explanation. _________

___________________________________________________________________________________

Directions: Report in Column A the total Number of gallons of gasoline, naphtha and other liquid motor fuel sold in the city limits. Report in Column B

the amount sold in the police jurisdiction.

Column A

Column B

City Limits

Police Jurisdiction

1. Total gallons of gasoline, naphtha, diesel and other liquid motor fuel sold

2. AMOUNT OF TAX -

Column A at one cent ($.01) per gallon and Column B at one-half cent ($.005) per gallon

3. TOTAL AMOUNT OF TAX DUE (Total of Line 2, Columns A & B)

NOTE: Distributor shall also report to whom such gasoline was sold, the date of the sale and the amount thereof below or in an accompanying schedule or statement.

SOLD TO: ____________________________________________________________________

DATE:_________________

AMOUNT: __________________________

SOLD TO: ____________________________________________________________________

DATE:_________________

AMOUNT: __________________________

SOLD TO: ____________________________________________________________________

DATE:_________________

AMOUNT: __________________________

(1) TOTAL TAX DUE

This return must be postmarked by the 20th day of the month following the reporting period

(Total of Item 3)