Form Dmf-100 - Alternative Fuels Tax Report
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2DMF-100 (12-08)
BUREAU OF MOTOR FUEL TAXES
PO BOX 280646
HARRISBURG PA 17128-0646
2009 ALTERNATIVE FUELS TAX REPORT
START
HERE
Corporation Name
TAX ID NUMBER (FEIN):
First Line of Corporation's Address
Beginning and Ending mm/dd/yyyy
TAX PERIOD:
Second Line of Corporation's Address
City
State
ZIP Code
DUE DATE:
Use this form to calculate and pay Liquid Fuels and Fuels Tax on alternative fuels placed into fuel supply tanks of alternative
fuel vehicles in Pennsylvania for use on a public highway.
SEE REVERSE SIDE FOR INSTRUCTIONS
TAX
ALTERNATIVE
VOLUME
TAX RATE
DUE
FUEL
=
x
CNG (gal)
gals
0.079 gal
x
=
Propane/LPG (gal)
gals
0.228 gal
=
x
ETHANOL (gal)
gals
0.208 gal
x
=
METHANOL (gal)
gals
0.154 gal
=
x
E-85 (gal)
gals
0.219 gal
x
=
M-85 (gal)
gals
0.178 gal
=
x
LNG (gal)
gals
0.182 gal
=
x
(kWh)
ELECTRICITY
kWh
0.0093 kWh
=
x
Other (specify)
FOR PREPAYMENT OF TAX INSTRUCTIONS, SEE REVERSE SIDE.
Amount Due:
Less Discount:
Make check payable to the “PA Dept. of Revenue”.
Total Due:
I certify that the information provided on this form has been examined by me and is, to the best of my knowledge, true and correct.
mm/dd/yyyy
Print Name
Title
Date
Signature
Telephone Number
Please remember to sign your DMF-100 after printing.
Mail this Alternative Fuels Tax Report along with your remittance to the address at the top of this form. To avoid
penalty and interest, file by the due date shown.
RETURN TO TOP
PRINT FORM
Reset Entire Form
THIS FORM MAY BE REPRODUCED AS NEEDED
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