Form A04 - Sales And Use Tax On Motor Fuel And Diesel Motor Fuel

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Annual Schedule FR
New York State Department of Taxation and Finance
File as an attachment to Form ST-101
Sales and Use Tax on
For tax period:
Motor Fuel and Diesel Motor Fuel
March 1, 2003, through February 29, 2004
Include with
Due date:
Form ST-101
Monday, March 22, 2004
A04
Sales tax identification number
Legal name
(Print ID# and name as shown on Form ST-101 or Certificate of Authority )
STEP 1 — Summary of gallons sold
Taxable gallons sold — Motor fuel
Non-taxable gallons sold
Taxable gallons sold
Regular
Mid-grade
Premium
diesel motor fuel
Diesel motor fuel
Motor fuel
gal.
gal.
gal.
gal.
gal.
gal.
➞ ➞ ➞ ➞ ➞
Gross sales of motor fuel and diesel motor fuel
STEP 2 — Summary of gross sales and total credits
$
.00
including exempt sales
➞ ➞ ➞ ➞ ➞
Total credits against tax on motor fuel and diesel motor fuel (except prepaid credits). See instructions for additional information.
$
Column C
Column D
Column E
Column F
STEP 3 — Calculate sales tax by jurisdiction
Motor fuel taxable
Diesel motor fuel taxable
Tax rate
Sales and
+
×
=
sales and self-use
sales and self-use
use tax
Column A
Column B
(C + D) x E
Taxing jurisdiction
Jurisdiction code
New York State only (3/1/03 - 5/31/03)
NE R0002
.00
.00
4%
New York State only (6/1/03 - 2/29/04)
NE R0011
.00
.00
4
1
/
%
4
Albany County (3/1/03 - 5/31/03)
AL R0179
.00
.00
8%
Albany County (6/1/03 - 2/29/04)
AL R0171
.00
.00
8
1
/
%
4
Allegany County (3/1/03 - 5/31/03)
AL R0215
.00
.00
8%
1
Allegany County (6/1/03 - 2/29/04)
AL R0211
.00
.00
8
/
%
4
Broome County (3/1/03 - 5/31/03)
BR R0313
.00
.00
8%
Broome County (6/1/03 - 2/29/04)
BR R0311
.00
.00
8
1
/
%
4
Cattaraugus County (outside the following) (3/1/03 - 5/31/03) CA R0499
.00
.00
8%
Cattaraugus County (outside the following) (6/1/03 - 2/29/04) CA R0491
.00
.00
8
1
/
%
4
Olean (city) (3/1/03 - 5/31/03)
OL R0419
.00
.00
8%
1
/
Olean (city) (6/1/03 - 2/29/04)
OL R0411
.00
.00
8
%
4
Salamanca (city) (3/1/03 - 5/31/03)
SA R0429
.00
.00
8%
Salamanca (city) (6/1/03 - 2/29/04)
SA R0421
.00
.00
8
1
/
%
4
Cayuga County (outside the following) (3/1/03 - 5/31/03) CA R0503
.00
.00
8%
1
Cayuga County (outside the following) (6/1/03 - 2/29/04) CA R0501
.00
.00
8
/
%
4
Auburn (city) (3/1/03 - 5/31/03)
AU R0552
.00
.00
8%
1
/
Auburn (city) (6/1/03 - 2/29/04)
AU R0551
.00
.00
8
%
4
Chautauqua County (3/1/03 - 5/31/03)
CH R0602
.00
.00
7%
Chautauqua County (6/1/03 - 2/29/04)
CH R0601
.00
.00
7
1
/
%
4
Chemung County (3/1/03 - 5/31/03)
CH R0708
.00
.00
8%
1
Chemung County (6/1/03 - 2/29/04)
CH R0701
.00
.00
8
/
%
4
Chenango County
CH R0820
.00
.00
8%
(outside the following) (3/1/03 - 5/31/03)
Chenango County
CH R0821
.00
.00
8
1
/
%
(outside the following) (6/1/03 - 2/29/04)
4
Norwich (city) (3/1/03 - 5/31/03)
NO R0849
.00
.00
8%
Norwich (city) (6/1/03 - 2/29/04)
NO R0841
.00
.00
8
1
/
%
4
Clinton County (3/1/03 - 5/31/03)
CL R0993
.00
.00
7%
1
/
Clinton County (6/1/03 - 2/29/04)
CL R0991
.00
.00
7
%
4
Columbia County (3/1/03 - 5/31/03)
CO R1003
.00
.00
8%
Columbia County (6/1/03 - 2/29/04)
CO R1001
.00
.00
8
1
/
%
4
Cortland County (3/1/03 - 5/31/03)
CO R1122
.00
.00
8%
Cortland County (6/1/03 - 2/29/04)
CO R1121
.00
.00
8
1
/
%
4
Delaware County (3/1/03 - 5/31/03)
DE R1205
.00
.00
7%
1
/
Delaware County (6/1/03 - 11/30/03)
DE R1201
.00
.00
7
%
4
Delaware County (12/1/03 - 2/29/04)
DE R1211
.00
.00
8
1
/
%
4
Dutchess County (3/1/03 - 5/31/03)
DU R1303
.00
.00
7¼%
Dutchess County (6/1/03 - 2/29/04)
DU R1301
.00
.00
8
1
/
%
4
Erie County (3/1/03 - 5/31/03)
ER R1415
.00
.00
8%
1
/
Erie County (6/1/03 - 2/29/04)
ER R1401
.00
.00
8
%
4
ST-101.10 (2/04)
To order forms, call 1 800 462-8100
Need help? call 1 800 972-1333
Page 1 of 6

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