Dor/dmv Form 593 - Ethanol Broker Return
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1Mail
Remittance Center
Ethanol Broker Return
Return to:
P.O. Box 5055
Sioux Falls, SD 57117-5055
License Number:
Return Period:
Return Due Date:
Check here if this is an amended report
Report in Whole Gross Gallons Only
ETHYL ALCOHOL RECEIPTS & SALES
1
1
Total gallons of ethyl alcohol received from the Ethanol Producer
2
2
Total gallons of ethyl alcohol sold to a licensed exporter for export. Attach Uniform Schedule of Disbursements - Type 6a
3
3
Total gallons of ethyl alcohol sold to U.S. government. Attach Uniform Schedule of Disbursements -- Type 8
4
4
Total gallons of ethyl alcohol sold to a licensed Ethanol Broker for resale. Attach Uniform Schedule of Disbursements -- Type 10
5
5
Total taxable gallons -- Subtract Line 2, 3, and 4 from Line 1
TAXES AND FEES DUE
6
6
Subtotal taxable gallons of ethyl alcohol -- Record Line 5 here Attach Uniform Schedule of Dirbursements -- Type 5
7
7
Allowance (if filing on time) -- Multiply Line 6 by 0.0225
8
8
Total taxable gallons -- Subtract Line 7 from Line 6
$0.08
9
9
Tax Rate
10
10
Taxes Due -- Multiply Line 8 by Line 9
11
11
Tank Inspection Fee -- Multiply Line 6 by 0.0200
12
12
Total Taxes and Fees Due -- Add Lines 10 and 11
13
13
Interest and Penalty (if filing after due date)
14
14
Balance Due of Credit from prior records (See Computer Notice)
15
15
Grand Total -- Add Lines 12 and 13, and add or subtract Line 14
SIGNATURE
I, ____________________________________ , for the ethanol broker name on the front of this report, do hereby certify under penalty of perjury that I have examined
this claim, and, to the best of my knowledge and belief, it is correct and complete.
Signature
Title
Date
DOR/DMV FORM 593(7/10)
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