Form 82-012a - Excess Tax Paid On Gasohol

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Iowa Department of Revenue
Excess Tax Paid on Gasohol
82-012a (06/22/11)
Name of Claimant: ______________________________
Claim Type 91
Attach to Form 82-006
FEIN: ______________________________
Send this claim to: Iowa Department of Revenue
Motor Fuel Unit, Examination
PO Box 10456
D
C
A
B
E
Des Moines, Iowa 50306-0456
Total Taxable
Tax Rate
Gross Gallons
Distribution
Total Tax Paid
or Fax to 515/281-3756, E-mail: idrmotorfuel@iowa.gov
Gallons
Allowance
(C x D)
Use Whole Gallons
(A - B)
Gallons
1. Alcohol purchased tax paid and blended with gasoline
2. Gasoline purchased tax paid and blended with alcohol
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9
3. Total tax paid on alcohol and gasoline portions of
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9
the blend. Add lines 1 and 2.
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9
4. Total tax due on gasohol (line 3; column C multiplied by gasohol rate)
5. Excess tax paid on gasohol (line 3; column E minus line 4)
INSTRUCTIONS:
Fuel Type (Tax per Gallon)
Complete the Excess Tax Paid on Gasohol Schedule on the reverse side and the
065 • Gasoline
123 • Alcohol (19¢)
Special Fuel Refund Claim 82-006.
7-1-07 to 6-30-08: (20.7¢)
124 • Gasohol (19¢)
Line 1: Complete columns A thru E by entering the alcohol gallons subject to
on or after 7-1-08: (21.0¢)
refund.
Line 2: Complete columns A thru E by entering the gasoline gallons subject to
refund.
Line 3: Add line 1 plus line 2 for columns A, B, C, and E.
Lines 1, 2, and 3:
Enter the number of gallons and the amount of tax paid for
Line 4: Complete column E by multiplying line 3 column C by the gasohol rate.
each portion of the blend, if each portion was purchased tax paid.
Line 5: Complete column E. Enter this amount on form 82-006, line 4.
Distribution allowance adjustment
Column A: Enter the Total Gallons from the schedule (reverse side) on line 1
If you receive a distribution allowance from a supplier or any allowance from
for alcohol and line 2 for gasoline, line 3 total.
your seller, this allowance must be used to reduce the number of gallons and
Column B: Enter the distribution allowance from the schedule (reverse side)
tax paid on the fuel. Usually, “distributors” are the only ones who receive this
on line 1 for alcohol and line 2 for gasoline, line 3 total.
allowance. Example: (Based on a gasoline tax rate of 21¢ on 5-30-09)
Column C: Subtract column B, from column A for lines 1, 2, and 3.
Distributor purchases 1,000 gallons of gasoline and receives a distribution
Column D: Enter the tax rate you were charged before any distribution
allowance of 1.2% from the seller. The number of gallons is 988 and the tax is
allowance. Refer to the Fuel Type table.
$207.48, not 1,000 gallons and $210 tax.
Column E: Multiply column C, total taxable gallons by column D, tax rate.
Signature
Daytime Phone
Date
E-mail
of Person to Contact

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