Form 82-053b - Retailers Motor Fuel Gallons Annual Report
Download a blank fillable Form 82-053b - Retailers Motor Fuel Gallons Annual Report in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Form 82-053b - Retailers Motor Fuel Gallons Annual Report with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2Reset Form
Print Form
Iowa Department of Revenue
Retailers Motor Fuel Gallons Annual Report
82-053a (10/28/08)
Period: Jan. 1, 2008, through Dec. 31, 2008
File a separate report for each retail location.
Report gross gallons for each type of fuel sold for final
January 31, 2009.
Due Date:
consumption.
Report whole gallons only.
Iowa License No: _______________________________
If you do not sell motor fuel at retail, please return the
Name: ________________________________________
form with zeros in the gallons column.
Address 1: _____________________________________
Complete for all types of fuel sold:
Type of Fuel
Gross Gallons
Address 2: _____________________________________
Gasoline (non-ethanol) Gallons .......... 1. ___________
City: __________________________________________
Ethanol Gallons (E10 Gallons only) ... 2. ___________
State: ______________ Zip Code: __________________
Ethanol Gallons (E85 Gallons only) ... 3. ___________
County Name: __________________________________
Diesel Gallons (including biodiesel)
Diesel (clear) Gallons ...................... 4. ___________
Social Security Number: __________________________
Diesel (dyed) Gallons ...................... 5. ___________
Federal Employer ID Number: _____________________
Total Gross Gallons For All
Iowa Sales Tax Permit No: ________________________
Fuel Types (add lines 1 thru 5) .......... 6. ___________
BIODIESEL
Mail To:
All locations selling biodiesel must complete one of the
following two sections — Sales or Purchases. If no
Iowa Department of Revenue
biodiesel is sold, complete Purchases with zeroes.
PO Box 10471
Des Moines, Iowa 50306-0471
Sales: If a breakdown of biodiesel sales is available,
provide gross gallons sold for each type.
Questions?
Type of Biodiesel
Gross Gallons
Call 515/281-3114 or 1-800-367-3388
Clear B2 ...................... 7a _________
E-mail idr@iowa.gov
Clear B5 ...................... 7b _________
Clear B10 .................... 7c _________
Clear B20 .................... 7d _________
Clear Other ................. 7e _________
SIGNATURE REQUIRED
Clear Biodiesel Subtotal
I, the undersigned, declare under penalty of perjury that
(add lines 7a thru 7e) .................. 7. ___________
I have examined this report, including all accompanying
Dyed B2 ....................... 8a _________
documentation, and to the best of my knowledge and
Dyed B5 ....................... 8b _________
belief, it is a true, accurate and complete statement.
Dyed B10 ..................... 8c _________
Dyed B20 ..................... 8d _________
Signature: __________________________________
Dyed Other .................. 8e _________
Dyed Biodiesel Subtotal
Date: ______________________________________
(add lines 8a thru 8e) .................... 8. ___________
Print Name: _________________________________
Total Biodiesel Sales (Gallons)
(add lines 7 and 8) ............................... 9. ___________
Title: ______________________________________
Purchases: Complete ONLY if a breakdown of biodiesel
Phone Number: ______________________________
sales by fuel type is not available.
Biodiesel (clear)
E-mail Address: ______________________________
B100 or B99 gallons .... 10a. ________
Biodiesel (dyed)
B100 or B99 gallons .... 10b. ________
Total Purchases of B100 blended with diesel
(add lines 10a thru 10b) ....................... 10. __________
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Financial