Form Sf-900 - Consolidated Special Fuel Monthly Tax Return - 2017
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4Indiana Department of Revenue
Form
SF-900
Consolidated Special Fuel Monthly Tax Return
State Form 49877
(R6 / 5-17)
Due date is the 20th of the following month.
For the month of:______________ 20______
Name of License Holder (as indicated on license)
License Number (as indicated on license)
Mailing Address
FEIN/SSN
City
State
ZIP Code
Business Phone Number Contact Name
Section 1: Filing Types
This is a consolidated return for all license types listed below. Place an “X” in the box to the left of each license type for which you are
licensed.
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Supplier
Permissive Supplier
Importer
Exporter
Blender
Dyed Fuel User
Section 2: Computation of Special Fuel Tax Due
1 Total Receipts (From Section A, Line 5)
1
2 Total Non-taxable Disbursements (From Section B, Line 11)
2
3 Taxable Gallons Sold or Used (From Section B, Line 3)
3
4 Gallons Received Tax Paid (From Section A, Line 1)
4
5 Billed Taxable Gallons (Line 3 minus Line 4)
5
6 Tax Due (Mulitply Line 5 by the applicable rate from the table)
6
7 Amount of Tax Uncollectible from Eligible Purchasers - Complete Schedule 10E
7
8 Adjusted Tax Due (Line 6 minus Line 7)
8
9 Collection Allowance (Line 8 multiplied by .016). If return filed or tax paid after due date enter
zero (0).
9
10 Adjustment - Complete Schedule E-1 (Dollar amount only)
10
11 Total Special Fuel Tax Due (Line 8 minus Line 9 plus or minus Line 10)
11
Section 3: Calculation of Oil Inspection Fee Due
1 Total Billed Gallons (From Section 2, Line 5)
1
2 Oil Inspection Fee Due (Multiply Line 1 by $0.01)
2
3 Adjustment (Schedule E-1 must be attached and is subject to department approval)
3
4 Total Oil Inspection Fee Due (Line 2 plus or minus Line 3)
4
Section 4: Calculation of Surcharge Tax Due
1 Total Billed Gallons (From Section 2, Line 5)
1
2 Surcharge Tax Due (Multiply Line 1 by the applicable rate from the table)
2
3 Adjustment (Schedule E-1 must be attached and is subject to department approval)
3
4 Total Surcharge Tax Due (Line 2 plus or minus Line 3)
4
Section 5: Calculation of Total Amount Due
1 Total Amount Due (Add Section 2, Line 11, plus Section 3, Line 4, plus Section 4, Line 4
1
Penalty (Penalty must be added if report is filed after the due date. 10% of tax due or $5.00,
2
whichever is greater.)
2
3 Interest (Interest must be added if report is filed after the due date.)
3
4 Net Tax Due (Add Line 1 plus Line 2 plus Line 3)
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5 Payment(s)
5
6 Balance Due (Line 4 minus Line 5)
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