Form Gt5 - Gasoline Distributor Tax Return Page 2
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Maine Revenue Services
00
Gasoline Distributor Tax Return
Page 2
*0908001*
Tax Computation
Gallons
Tax
.
,
,
,
,
Taxable Sales of Gasoline
Sch 5
9.
@ $.300
.
,
,
,
,
Taxable Sales of E10
Sch 5
10.
@ $.300
.
,
,
,
,
Taxable Sales of __________________
Sch 5
11.
@ ______
.
,
,
,
,
Taxable Sales of Aviation Gas
Sch 5
12.
@ $.300
.
,
,
,
,
Taxable Sales of Jet Fuel
Sch 5
13.
@ $.034
,
,
Total Taxable Gallons Sold
(must equal line 8)
14.
.
,
,
Net Excise Tax Due
(total lines 9 thru 13)
15.
.
,
,
Dealer Credit Card Sales to U.S. Government
Sch 22
16.
.
,
,
Excise Tax Paid Purchases
Sch 1
17.
.
,
,
Credit from Prior Period
18.
.
,
,
Amount Due
Line 15 less lines 16, 17 and 18. Use line 20 if result is a credit.
19.
Must equal lines 21+22+23
.
,
,
Credit Due
If line 15 minus lines 16, 17 and 18 is a credit, enter the amount to the right.
20.
Must equal lines 21+22+23.
If you wish a refund rather than a carry forward to the next period, check here.
.
,
,
Net Excise Tax - Gasoline
(Total lines 9, 10, 11)
21.
.
,
,
Net Excise Tax - Aviation Fuel
(Total line 12)
22.
.
,
,
Net Excise Tax - Jet Fuel
(Total line 13)
23.
The following are attached to this return to support one or more of the above schedules:
/
Mail To:
Receipts schedules 1
2
3
4
Maine Revenue Service
Disbursements
5
6
7
8
9
10
P.O. Box 1065
Augusta, ME 04332-1065
Credits
22
Make check or money order payable to the TREASURER, STATE OF MAINE and send your remittance with your return postmarked by the due
date printed on the top of the return. Please record your registration number on your check. Failure to file a return on or before the due date will
result in interest and penalty charges. Billings will be issued shortly after the processing of your return. A return must be filed even if there were
no sales or purchases during the period.
Print Name
Signature/Title
Date
Phone #
GT-5 Revised 07/2011
For assistance in completing this form, call (207) 624-9609
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