Form Tob-Sttfc - Monthly Underground And Aboveground Storage Tank Trust Fund Charge
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1
2TOB: STTFC
6/02
A
D
R
OFFICE USE ONLY
LABAMA
EPARTMENT OF
EVENUE
S
, U
& B
T
D
ALES
SE
USINESS
AX
IVISION
T
T
S
OBACCO
AX
ECTION
P.O. B
327556 • M
, AL 36132-7556 • (334) 242-9627
OX
ONTGOMERY
Monthly Underground and Aboveground
Storage Tank Trust Fund Charge
NAME
ADDRESS
CN: ________________________________________________
CITY
STATE
ZIP
(OFFICE USE ONLY)
Month of _____________________________________, _______
Check here if new address
Contact Person: _______________________________________
FEIN/SSN:
Permit Number: CT
–
Phone Number: (________)______________________________
COLUMN A
COLUMN B*
COLUMN C
COLUMN D
OFFICE USE ONLY
Scale for Charging Graduated Fee
Indicate Number of Withdrawals from
Rate of Charge
Amount Due
Based on Invoiced Gallons Withdrawn
Bulk or Deliveries from Out-of-State
from Bulk in Alabama or Gallons
Next to the Appropriate Range in
(Multiply Column B by Column C)
Delivered into this State.
Col. A. (See Reverse)
1
0-500
$ 1.50
501-1000
$ 3.00
2
3
1001-1500
$ 4.50
4
1501-2000
$ 6.00
2001-2500
$ 7.50
5
6
2501-3000
$ 9.00
7
3001-3500
$10.50
8
3501-4000
$12.00
9
4001-4500
$13.50
10
4501-5000
$15.00
11
5001-5500
$16.50
5501-6000
$18.00
12
13
6001-6500
$19.50
14
6501-7000
$21.00
7001-7500
$21.50
15
16
7501-8000
$24.00
17
8001-8500
$25.50
18
8501 or More
$27.00
19
$
0.00
Fee Due (Add Column D, lines 1 through 18) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
20
$
Late Filing Penalty (The greater of 10% of line 19 or $50). . . . . . . . . . . . . . . . . . . . . . . . .
21
$
Late Payment Penalty (10% of line 19) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
22
$
Interest (Contact the Department for rate). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
23
$
0.00
Gross Amount Due (Add lines 19 through 22) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
24
$
Less Authorized Credit (Attach Letter) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
0.00
$
25
Net Amount Due (Line 23 minus line 24) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
26
$
Amount Remitted. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Check here if payment is remitted through EFT
DO NOT TAKE CREDITS UNLESS GIVEN AUTHORIZATION!
Under penalties of perjury, I hereby certify this return to be true and accurate.
Signature: _____________________________________________
Date: ________________________________________________
Title: __________________________________________________
ALL PREVIOUS FORMS ARE OBSOLETE AND SHOULD BE DESTROYED.
Mail this return to the address above with remittance payable to the Alabama Department of Revenue, on or before the 20th of each
month. Even if there is no activity during the month, a return must be filed and marked “No Activity”.
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