Clear form
Utah State Tax Commission
SD
Special Fuel Supplier
TC-364
Rev. 4/99
Tax Return
IMPORTANT NOTICE: Please make address or name corrections to
this return. If new locations are added or changes in ownership are
made, contact the Tax Commission for appropriate forms/applications.
Name and address
Due date
Tax period
Account number
Check this box if this is an AMENDED return. Enter the amended period in the "Tax period" indicated above:
If this will be your LAST return, enter the last day of business:
Example: Enter date like this 07 30 97
Receipts
Deductions
1.
Diesel Fuel inventory at beginning of month
9.
Exported from Utah (attach form TC-364B)
1
9
2.
Manufactured, compounded
10.
Dyed diesel sales (attach form TC-364B)
2
10
Exempt sales (to Division of Air Quality
Dyed diesel purchases (attach form TC-364A)
3.
11.
3
certificate holders) (attach form TC-364B)
11
Blend products (attach form TC-364A)
4.
Utah tax paid purchases (same as line 6)
12.
4
12
Imported to Utah (attach form TC-364A)
5.
13.
Exchange disbursements (attach form TC-364B)
5
13
Utah tax paid purchases (attach form TC-364A)
6.
14.
Diesel Fuel inventory at end of month
6
14
Exchange receipts (attach form TC-364A)
7.
15.
TOTAL DEDUCTIONS (add lines 9 through 14)
7
15
TAXABLE GALLONS
8
TOTAL SPECIAL FUEL AVAILABLE
8.
16.
16
(subtract line 15 from line 8)
(add lines 1 through 7)
17.
Tax rate (24.5 cents per gallon)
17
x .245
You must file this tax return, even if there is no
tax liability for the tax period.
TAX DUE (multiply line 16 by line 17)
18.
18
00
AMENDED RETURNS ONLY - credit for tax
19.
19
00
paid on original return
20
Penalty and Interest
20.
00
NET DUE (round to whole dollars)
21
21.
00
(subtract line 19 from line 18, then add line 20)
Return ENTIRE form, coupon, and payment to the Utah State Tax Commission
364.FRM Rev. 4/99
Account number
Filing Period
Tax Type
Amount
$
PAID
I declare under the penalties provided by law that to the best of my knowledge this is a
true and correct return.
Make check or money order payable to the Utah State Tax
Commission. Do not send cash. Do not staple check to this
Authorized Signature
Telephone
Date
coupon. Put your account number on your check.
SPECIAL FUEL SUPPLIER RETURN
UTAH STATE TAX COMMISSION
210 N 1950 W
SLC UT 84134-0500
*841340500*