Form Sf-900x - Amended Consolidated Special Fuel Monthly Tax Return - Indiana Department Of Revenue Page 2

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A
B
C
As Reported or Last
Amount of Change (Supporting
Current
Determined
Schedule Must Be Attached)
Amount
Use Whole
Use Whole
From
Use Whole
Section A:
Receipts
Gallons Only
Schedule
Gallons Only
Gallons Only
1.
Gallons Received Tax Paid (Carry forward to Section 2, Line 4
on front of return)
1
2.
Gallons Received for Export (To be completed only by licensed exporters)
2E
3.
Gallons of Nontaxable Fuel Received and Sold or Used For a Taxable
Purpose
2K
4.
Gallons Imported Via Truck, Barge, or Rail, Tax Unpaid
3
5.
Total Receipts (Add Lines 1 through 4, carry forward to Section 2, Line 1
on front of return)
From
Use Whole
Use Whole
Use Whole
Section B:
Disbursements
Schedule
Gallons Only
Gallons Only
Gallons Only
1.
Gallons Delivered Tax Collected and Gallons Blended or Dyed Fuel Used
5
+
2.
Diversions (Special fuel only)
-
11
3.
Taxable Gallons Sold or Used (Carry forward to Section 2, Line 3
on front of return)
4.
Gallons Delivered Via Rail, Pipeline or Vessel to Licensed Suppliers,
Tax Not Collected
6
5.
Gallons Disbursed on Exchange for Other Suppliers or Permissive
Suppliers
6X
6.
Gallons Exported by License Holder
7
7.
Gallons Sold to Unlicensed Exporters for Export
7A
8.
Gallons Sold to Licensed Exporters for Export
7B
9.
Gallons of Undyed Fuel Sold to the U.S. Government - Tax Exempt
8
10. Gallons Sold of Tax Exempt Dyed Fuel
10
11. Total Non-Taxable Disbursements (Add Lines 4 through 10;
carry forward to Section 2, Line 2 on front of return)
(Information Only) Reporting of IVP Numbers Given By the Department
IVP Number
IVP Payment
IVP Number
IVP Payment
1.
7.
2.
8.
3.
9.
4.
10.
5.
11.
6.
12.

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