Form 1531 - Distributor Monthly Report Of Motor Vehicle Fuel Delivered For Marine Use

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MISSOURI DEPARTMENT OF REVENUE

FORM

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TAXATION DIVISION

1531

P.O. BOX 300

JEFFERSON CITY, MO 65105-0300

(573) 751-7671

TDD 1-800-735-2966

(REV. 02-2011)

GASOLINE DELIVERED FOR MARINE USE

DISTRIBUTOR NAME/ADDRESS

DISTRIBUTOR MONTHLY REPORT OF MOTOR

VEHICLE FUEL DELIVERED FOR MARINE USE.

(This report must be filed in addition to the

Distributor’s Monthly Tax Report covering gaso-

line, if marine use fuel is delivered in any of the

qualifying counties listed on the back of this form.)

REPORTING MONTH/YEAR

___ ___ / ___ ___ ___ ___

DISTRIBUTOR’S LICENSE NUMBER

IMPORTANT NOTES

1. A copy of the invoice for each delivery must accompany this report. Group all invoices by county and secure as a group with fastener.

2. Do not send any payment with this report.

3. If additional space is needed, use blank sheet and identify columns as below.

If you have questions or need assistance in completing this form, please call this office at (573) 751-7671 or e-mail excise@dor.mo.gov. You may also

obtain a copy of this form from the Department’s web site:

I. Enter name of each qualifying

II. Enter total number of deliveries

III. Enter total gallons of gasoline

IV. Enter total dollar amount of

county in which a delivery was

made in each qualifying county for

delivered in qualifying county

motor fuel tax collected on

made. (See reverse side.)

marine use. (See reverse side.)

for marine use.

gasoline shown in Column III.

I, the undersigned, upon my oath, declare that the statements made hereon and the invoices attached including the copies of the delivery tickets are true and

correct to the best of my knowledge.

NAME

TITLE

DATE

__ __ / __ __ / __ __ __ __

MO 860-1176 (02-2011)

DEPARTMENT OF REVENUE’S COPY

This publication is available upon request in alternative accessible format(s).