Form M-20a - Monthly Return Of Liquid Fuel Tax And Environmental Response Tax - Hawaii Department Of Taxation

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STATE OF HAWAII - DEPARTMENT OF TAXATION
FORM M-20A
MONTHLY RETURN OF LIQUID FUEL TAX
(REV. 2001)
TO BE FILED
AND ENVIRONMENTAL RESPONSE TAX
BY DISTRIBUTOR
(Chapter 243, HRS)
£
£
£
IF APPLICABLE, CHECK BOX:
INITIAL RETURN
AMENDED RETURN
FINAL RETURN
Name of Distributor
Permit Number
NOTE:
This return
Please
with payment must be
Print
s u b m i t t e d t o y o u r
Business address (Number and Street)
FEIN Number
taxation district on or
or
before the last day of
Type
the month following the
City, State, ZIP code
Period Covered
c l o s e o f t h e f i l i n g
period.
PART I — COMPUTATION OF FUEL AND ENVIRONMENTAL RESPONSE TAX
(a)
(b)
(c)
(d)
(e) Add cols. a to d
LIQUID FUEL CLASSIFICATION
CITY & COUNTY
COUNTY OF MAUI
COUNTY OF
COUNTY OF KAUAI
TOTAL OF ALL
OF HONOLULU
(Use Part II Summary)
HAWAII
(Use Part II Summary)
COUNTIES
On Highway Diesel Oil and Liquid Fuel
1. Diesel - On Hwy.
Gals.
2. Gasoline & Other Liquid Fuel:
a. Premium
Gals.
b. Regular
Gals.
c. Unleaded
Gals.
d. Others (specify):
Gals.
Gals.
3. Total (2a through 2e)
Gals.
4. Total (Add lines 1 and 3) Gals.
5.
Tax Rate
.325
.29
.248
.29
6. Total tax for On Highway Diesel Oil
and Liquid Fuel
On Highway LPG
7. LPG - On Hwy.
Gals.
8.
Tax Rate
.22/.107*
.20/.096*
.17/.081*
.20/.096*
9. Total tax for On Highway LPG
Off Highway Liquid Fuel
10. Aviation
Gals.
11. Diesel - Off Hwy.
Gals.
12. LPG and Alternative
Fuels - Off Hwy.
Gals.
13. Total (Add lines 10 thru 12) Gals.
14.
Tax Rate
.01
.01
.01
.01
15. Total tax for Off Highway Liquid Fuel
On Highway Alternative Fuel
(see
16.
Gals.
instructions)
17. Tax Rate (see instructions)
18. Tax Due
19. Grand Total - Gallons
Add lines 4, 7, 13, and 16
20. Total Fuel Tax - Add lines 6, 9, 15, and 18
ENVIRONMENTAL RESPONSE TAX
21. Petroleum Products (Number of barrels)
22. Tax @ 5 cents per barrel
.05
23. Total Environmental Response Tax
24. TOTAL TAXES DUE —
Add Lines 20e and 23e
Complete Parts II and III on the reverse side
DECLARATION
I declare, under the penalties set forth in section 231-36, HRS, that this is a true, correct, and complete return, prepared in accordance with the provisions of the Fuel Tax Law and the
rules issued thereunder.
SIGNATURE
TITLE
DATE
*Effective for taxable years beginning after December 31, 2001. (Act 143, Session Laws of Hawaii 2001)
FORM M-20A

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