Form Op-218 - Gross Earnings Petroleum Tax
Download a blank fillable Form Op-218 - Gross Earnings Petroleum Tax in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Form Op-218 - Gross Earnings Petroleum Tax with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1STATE OF CONNECTICUT
DEPARTMENT OF REVENUE SERVICES
GROSS EARNINGS PETROLEUM TAX
THIS CERTIFICATION APPLIES TO PRODUCTS PURCHASED IN CONNECTICUT BUT SOLD OUT OF STATE.
Name of Exporting Company
Address
City or Town
State
Zip Code
Name of Seller
Period Covered
State Shipped To
EXPORTING COMPANY’S CERTIFICATION
This will certify that we have sold the petroleum products reflected below, in the quantities shown, outside of the State of Connecticut. This
product was purchased in the State of Connecticut and the 5% gross earnings tax was paid on the monetary amount indicated. It is requested
that the payment be made in the amount of $ __________________ representing refund as stated in Conn. Gen. Stat. §12-587a.
TYPE OF PRODUCTS
GALLONS
PURCHASE PRICE
$
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7
TOTAL PURCHASES
$
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7
5% Gross Earnings Tax Paid
$
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7
I declare, under the penalties of false statement that I have examined this form and to the best of my knowledge and belief it is
true, complete and correct.
Signed
T i t l e
Date
ORIGINAL PURCHASER ENDORSEMENT (IF DIFFERENT THAN FIRST SELLER)
TO
This will certify that information shown above is correct. A credit in the amount of
$ _____________ has been made to _________________________________________________________________________________
(Name and Address of Distributor)
______________________________________________________________________________________________________________
We hereby request reimbursement in the amount reflected above.
______________________________________________________________________________________________________________
Name of Original Purchaser
Signed
Title
of OP-161, Petroleum Products Gross Earnings Tax Return
Take this deduction on Line 5
and enclose a copy of
OP-218 (REV 11/98)
this form when filing your tax return.
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Financial