Pet 356 (Tax Report '05) - Liquified Gas User Annual Tax Return - Tennessee Department Of Revenue
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3TENNESSEE DEPARTMENT OF REVENUE
LIQUIFIED GAS USER ANNUAL TAX RETURN
Account No.
Filing Period
SSN
PET
Beginning:
or
356
Due Date
Ending:
FEIN
Returns must be postmarked by the due date
to avoid the assessment of penalty and inter-
est. 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 11 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. Please read instructions on back before preparing this return.
IF AN AMENDED
2. Maintain adequate records to support return.
RETURN
3. Be sure to sign and date in the signature box below.
CHECK HERE
4. If this is an amended return, please indicate "Filing Period" and check the appropriate box on the front
of the return.
1. Total gallons consumed in Tennessee; round to the nearest gallon (Total from Schedule A, Line 7) ............. (1)
_______________________________
.
2. Tax due per mileage (Multiply Line 1 by Liquified Gas tax rate of $
) ........................................................ (2)
$ ______________________________
3. Cost of decals purchased July 1 through June 9 .............................................................................................. (3)
$ ______________________________
.
4. Cost of decals purchased for period June 10 through June 30 ........................................................................ (4)
$ ______________________________
.
5. Total cost of decals purchased during filing period (Add lines 3 and 4) .......................................................... (5)
$ ______________________________
.
6. Credit Due (Complete if Line 5 is greater than Line 2 and one or more requirements in Schedule B applies) . (6)
$ ______________________________
.
7. Tax Due (If Line 2 is greater than Line 5, enter difference) .............................................................................. (7)
$ ______________________________
.
8. Credit (Enter outstanding credit amount from previous Department of Revenue notices) ............................... (8)
$ ______________________________
.
{
If filed LATE, compute penalty at 5% of the tax (Line 7 minus Line 8) for each 1 to 30 DAY PERIOD or portion thereof for
9. Penalty
......... (9)
$ ______________________________
which TAX 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.
.
If filed late, compute interest at
% per annum on the tax (Line 7 minus Line 8) from
10. Interest -
....... (10)
$ ______________________________
the due date to the date of payment
.
11. Total Remittance Amount (Add lines 7, 9, and 10; subtract Line 8 if applicable) ............................................ (11)
$ ______________________________
Under penalties of perjury, I declare that I have examined this report, and to the best of my knowledge
and belief, it is true, correct, and complete.
FOR OFFICE
USE ONLY
Date
President or Other Principle Officer
Date
Signature of Preparer other than Taxpayer
Tax Preparer's Address
Phone Number
RV-R0004401
INTERNET (11-05)
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