Form Mf-002 - Wisconsin Combined Monthly Fuel Summary Report
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1
2MF-002: Wisconsin Combined
Monthly Fuel Summary Report
Section 1
Use BLACK INK Only
Legal Name
Tax Account Number
Report for month ending (MM DD CCYY)
Mailing Address - Street or PO Box Number
FEIN/SSN Number
City
State
Zip Code
Type of change
Date of change (MM DD CCYY)
Ownership
Name
Address
NO ACTIVITY
Section 2: Motor Vehicle Fuel Suppliers Report
Column 1
Column 2
Column 3
Fuel Disbursements in Gross Gallons
Gasoline
Undyed Diesel
Other Fuels
1 Fuel originating from IRS Registered Terminals (Sch. TD) . . . . . . . . . . . . . . . . . . . . .
1
2 Fuel originating from locations other than IRS Registered Terminals (Sch. OD) . . . . .
2
3 SUBTOTAL (add lines 1 and 2 in each column). . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3
4 Tax and fee paid fuel delivered to IRS Registered Terminal (Sch. 1F). . . . . . . . . . . . .
4
5 Tax and fee paid fuel exported from Wisconsin (Sch. 7) . . . . . . . . . . . . . . . . . . . . . . .
5
6 Tax and fee paid fuel sold to the US Government (Sch. 8) . . . . . . . . . . . . . . . . . . . . .
6
7 SUBTOTAL (add lines 4, 5 and 6 in each column). . . . . . . . . . . . . . . . . . . . . . . . . . . .
7
8 GALLONS SUBJECT TO THE PETROLEUM INSPECTION FEE (line 3 less line 7)
8
9 Tax and fee paid gasoline sold exempt for off-road use (Sch. 10A). . . . . . . . . . . . . . .
9
10 Tax and fee paid gasoline sold exempt to aviation fuel dealers (Sch. 10B) . . . . . . . . . 10
11 Tax and fee paid fuel sold exempt for urban mass transit (Sch. 10C) . . . . . . . . . . . . . 11
12 Tax and fee paid fuel sales representing uncollectible fuel taxes (Sch. 10E) . . . . . . . 12
13 Tax and fee paid undyed diesel fuel sold exempt for trains (Sch. 10G) . . . . . . . . . . . . 13
14 Tax and fee paid undyed diesel fuel sold exempt for heating oil (Sch. 10H) . . . . . . . . 14
15 Tax and fee paid fuel sold exempt to Native Americans (Sch. 10T). . . . . . . . . . . . . . . 15
16 SUBTOTAL (add lines 9 through 15) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
17 GALLONS SUBJECT TO THE MOTOR VEHICLE FUEL TAX (line 8 less line 16) . . 17
Summary of Motor Vehicle Fuel Tax
Gasoline
Undyed Diesel
Other Fuels
18 Enter gallons from line 17 above (columns 1 and 2) . . . . . . . . . . . . . . . . . . . . . . . . . . 18
19 LESS GAS ALLOWANCE (line 18, column 1 x .0135). . . . . . . . . . . . . . . . . . . . . . . . . 19
20 Subtotal (line 18 less line 19 in each column) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
21 TOTAL GALLONS SUBJECT TO FUEL TAX (add columns 1, 2, and 3 on line 20). . 21
x .309
22 Wisconsin fuel tax rate per gallon . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
$
23 MOTOR VEHICLE FUEL TAX DUE (multiply line 21 by rate on line 22). . . . . . . . . . . 23
Gasoline
Undyed Diesel
Other Fuels
Summary of Petroleum Inspection Fee
24 Enter gallons from line 8 above (columns 1, 2, and 3). . . . . . . . . . . . . . . . . . . . . . . . . 24
25 TOTAL GALLONS SUBJECT TO THE FEE (add columns 1, 2, and 3 on line 24). . . 25
x .02
26 Petroleum inspection fee per gallon. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
27 PETROLEUM INSPECTION FEE DUE ( multiply line 25 by rate on line 26) . . . . . . . 27
$
28 TOTAL TAX AND PETROLEUM INSPECTION FEE DUE (add lines 23 and 27) . . . . 28
$
29 Late filing fee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
$
$
30 Interest - If paid late, add interest at the rate of 1.5% per month (.0005/day) . . . . . . . 30
$
31 TOTAL DUE (add lines 28, 29, and 30) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
Gasoline
Undyed Diesel
Other Fuels
Fuel Disbursements Not Subject to Motor Vehicle Fuel Tax or Petroleum
Inspection Fee
32 Fuel originating from Wisconsin IRS Registered Terminals (Sch. TD) exported out
of state . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
MF-002 (R. 2-12)
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Parent category: Financial