International Fuel Tax Agreement Tax Return Form - 2002
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1
2SOUTH DAKOTA
Reporting Period: 200302
Ending Period: 06/30/2003
Return Due Date: 07/31/2003
License Number:
Fuel Type: D
INTERNATIONAL FUEL TAX AGREEMENT TAX RETURN
A.
Total Miles Traveled in all
States
B.
Total Fuel Consumed in all
States
C.
*Average Miles/Gallon (Line
A Divided by Line B)
Name:
South Dakota Department of Revenue
Mail To:
Remittance Center
Address:
PO BOX 5055
City, State, Zip:
Sioux Falls, SD 57117-5055
A RETURN MUST BE FILED EVEN IF NO MILES TRAVELED
1
2
3
4
5
6
7
8
9
10
Total Taxable
Tax Paid
Interest Due
Taxable Gallons
Net Gallons
Tax Due/Credit
Tot Due/Credit
Jurisdiction
Total Miles
Tax Rate
Miles
Gallons
.0100
(Col 3/Line C)
(Col 4- Col 5)
(Col 6 x Col 7)
(Col 8 + Col 9)
SD
0.2200
AB
0.2297
AL
0.1700
AR
0.2250
AZ
0.2600
BC
0.3827
CA
0.2630
CO
0.2050
CT
0.2600
DE
0.2200
FL
0.2877
GA
0.1189
IA
0.2250
ID
0.2500
IL
0.2870
IN
0.1600
I2
0.1100
KS
0.2500
KY
0.1200
K2
0.0520
LA
0.2000
MA
0.2100
MB
0.2781
Page 1
Total IFTA Miles Page 1
TOTAL OF COLUMN 10 Page 1
Page 2
Total IFTA Miles Page 2
TOTAL OF COLUMN 10 Page 2
SUBTOTAL
Total IFTA Miles
GRAND TOTAL COLUMN 10
PENALTY - 10%of Tax Due or
ADD
Total Mileage of all NON-IFTA States and Provinces
$50.00, whichever is greater
GRAND
(+ or -) Balance Due/Credit from
Total All Miles Traveled (Same as (A) above)
TOTAL
Prior Return
TOTAL DUE
* When calculating your average miles per gallon, extend two decimals only (ex. 2.86)
**When recording gallons, round up to the nearest whole gallon (ex. 52.8 = 53)
TOTAL REMITTED
I CERTIFY THAT THIS REPORT IS TRUE, CORRECT AND COMPLETE TO THE BEST OF MY KNOWLEDGE
TO CANCEL IFTA LICENSE, ATTACH IFTA PERMIT AND GIVE LAST DATE OF
OPERATION __________________
DATE
SIGNATURE – LICENSEE
NOTE: Please see information on Page 2
PHONE NO.
TITLE
Note: Please photocopy this return for your records. Please use black ink.
Page 1
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