Indiana Revenue Form Sf-401 - Transporter'S Monthly Tax Return

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Indiana Revenue Form
INDIANA DEPARTMENT OF REVENUE
SF-401
TRANSPORTER'S
(R / 3-02)
MONTHLY TAX RETURN
State Form 46287
Due date is the 25th of the following month.
For the month of:_________________, 20____
Name of License Holder (As indicated on License)
Mailing Address (Street or P.O. Box Number)
State
Zip Code
Telephone Number
City or Town
(
)
License Number
Federal Identification Number
Motor Carrier / IFTA Number
Net Gallons
From
Column A
Column B
Column C
Schedule
Other Products
Special Fuel
Gasoline
(Jet Fuel,
(Dyed and Clear
(Gasoline,
Kerosene)
Diesel Fuel)
Gasohol)
1. Total gallons of Special Fuel loaded from an Indiana
1A
terminal or bulk plant and delivered to another state.
2. Total gallons of Special Fuel loaded from an out-of-state
2A
terminal or bulk plant and delivered into Indiana.
3. Total gallons of Special Fuel loaded from an Indiana
3A
terminal or bulk plant and delivered within Indiana.
4. Total gallons of Special Fuel transported (Add lines 1,
2, and 3).
Transporter's Schedule of Deliveries, Schedules 1A, 2A,
and 3A must be attached to this report
Mail Return To: Indiana Department of Revenue, P.O. Box 6080, Indianapolis, IN 46206-6080
Under penalty of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best
of my knowledge and belief it is true, correct, and complete. I further declare that complete and proper records are on file at the
address indicated above for all fuel reported on this return.
Title
Taxpayer or Authorized Agent
Typed or Printed Name
Telephone Number
Date Signed
(
)
IMPORTANT: A return must be filed each month, within 25 days following the last day of the month being reported.
Failure to submit this report could result in a civil penalty of $1,000 for each violation.

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