Form Gas-1301 - Motor Fuel Transporter Return Form - North Carolina Department Of Revenue

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Motor Fuel Transporter Return
North Carolina Department of Revenue
GAS-1301
1-08
MFD
Legal Name
(First 30 Characters) (USE CAPITAL LETTERS FOR YOUR NAME AND ADDRESS)
Fill in applicable circles:
Trade Name
Amended Report
Final Report
Address has changed since prior report
Location
County
Account Number
Mailing Address
State
Zip Code (First 5 digits)
City
Return for Month of
Month
Year
Phone Number
Name of Contact Person
Fax Number
-
(
)
(
)
Computation of Net Gallons
1.
Total gallons of motor fuels loaded at a North Carolina
,
,
,
terminal or bulk plant and delivered to another state
1.
(Attach Gas 1301DS, Schedule 14A)
2.
Total gallons of motor fuels loaded at an out-of-state terminal
,
,
,
o r bulk plant and delivered in North Carolina
2.
(Attach Gas 1301DS, Schedule 14B)
3.
Total gallons of motor fuels loaded at a North Carolina
,
,
,
terminal or bulk plant and delivered in North Carolina
3.
(Attach Gas 1301DS, Schedule 14C)
,
,
,
4.
Total gallons of motor fuels transported
4.
(Add Lines 1, 2, and 3)
5.
Penalty for Late Filing
.
$
00
5.
($50.00)
Signature and Title:
Date:
I certify that, to the best of my knowledge, this report is accurate and complete.
Reports are due by the 22nd day after the end of each month.
Any payment must be drawn on a U.S. (domestic) bank and payable in U.S. dollars.
MAIL TO:
QUESTIONS:
North Carolina Department of Revenue
Contact the Motor Fuels Tax Division at:
Motor Fuels Tax Division
Telephone Number
(919) 733-3409
Post Office Box 25000
Toll Free Number
(877) 308-9092
Raleigh, North Carolina 27640-0950
Fax Number
(919) 733-8654

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