Form Tc-109a - Aviation Fuel Tax Return - Utah State Tax Commission
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1AV
Utah State Tax Commission
TC-109A
Aviation Fuel Tax Return
Rev. 7/01
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.
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 00
Receipts
Continue Deductions
Aviation Fuel inventory at beginning
Utah tax paid purchases (same as line 6)
12
12.
1.
1
of month (Utah refiners only)
Aviation Fuel inventory at end of month
Manufactured, compounded or blended
13.
2.
(Utah refiners only)
13
2
Transfers from motor fuel
3.
TOTAL DEDUCTIONS (add lines 8 through 13)
14.
14
3
Imported to Utah (attach form TC-110A)
4.
15
TAXABLE GALLONS (subtract line 14 from 7)
15.
4
Exempt purchases from licensed distributor
00
Minimum tax per gallons (multiply line 15 by .04)
5.
16
$
16.
(attach form TC-110E)
5
Gallons subject to the additional tax from form
17.
6.
Utah tax paid purchases (attach form TC-110B)
TC-110K1 (attach TC-110K1 & TC-110K2)
6
17
TOTAL AVIATION FUEL AVAILABLE
Additional tax on gallons from line 17 above
00
7.
18.
7
18 $
(add lines 1 through 6)
(multiply line 17 by .05)
Deductions
00
TAX SUBTOTAL (add lines 16 and 18)
$
19.
19
Exported from Utah (attach form TC-110D1
8.
2% allowance for evaporation, handling and
00
or TC-110D2)
8
20.
20 $
expense of collection (multiply line 19 by .02)
Qualified government sales (attach form
9.
00
TC-110G and copies of invoice)
9
$
21.
TAX TOTAL (subtract line 20 from 19)
21
Exempt sales to licensed distributors
FOR AMENDED RETURNS ONLY - credit for
10.
00
10
(attach form TC-110F)
22.
22 $
tax paid on original return
Conversions to non-aviation fuel use
11.
00
11
23
$
Penalty and Interest
23.
(attach form TC-110J)
TOTAL DUE (add lines 21 and 23)
00
24.
$
24
I declare under penalties of law to the best of my knowledge this is a true and correct return.
File return, even if tax liability is ZERO for period
Authorized Signature
Telephone
Date
Return ENTIRE form, coupon, and payment to the Utah State Tax Commission
109A.FRM Rev. 7/01
Account number
Filing Period
Tax Type
Amount
$
PAID
Make check or money order payable to the Utah State Tax
Commission.
Do not send cash. Do not staple check to this
coupon. Put your account number on your check.
AVIATION FUEL TAX RETURN
UTAH STATE TAX COMMISSION
210 N 1950 W
SLC UT
84134-0540
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