Attach To Form 82-006-Worksheet 82-012 - Excess Tax Paid On Gasohol

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I O WA
d e p a r t m e n t o f R e v e n u e a n d F i n a n c e
Excess Tax Paid on Gasohol
Name of
Claimant ______________________
Worksheet 82-012 (4/02) CU
Attach to Form 82-006
FEIN _________________________
Boxes 1, 2, 3, 4:
Total number of
Total tax paid on
Alcohol purchased tax paid
alcohol gallons
alcohol
AND
1
2
blended with gasoline
must
Total number of
Total tax paid on
¢
Gasoline purchased tax paid
gasoline gallons
gasoline
AND
4
3
not
blended with alcohol
Number of gallons
Total tax paid on
gasohol
Gasohol with tax paid
Box 1
Box 3
Box 2
Box 4
PLUS
PLUS
on BOTH the
Boxes 5 and 6:
5
6
alcohol
AND
Total tax due on
gasoline
gasohol
portions of the blend
Box 7:
7
Excess tax paid on gasohol
Tax PAID on
Tax DUE
Box 8:
Box 6
Box 7
MINUS
gasohol
LESS
on gasohol
EQUALS
8
The schedule on the reverse side must be completed to process your claim.

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