Form Mf-017 - Wisconsin Blender'S Fuel Report
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2MF-017: Wisconsin Blender’s Fuel Report
Month Covered (MM DD YYYY)
Use BLACK INK Only
Legal Name
Tax Account Number
FEIN / SSN
Business Name (DBA)
Mailing Address
City
State
Zip Code
/
/
Cancel my permit effective
Check if this is an amended return
(MM DD YYYY)
Check if address, name, or entity change
Check if correspondence is included
Print numbers like this
Not like this
NO COMMAS
Other
Computation of Fuel Tax Due
Kerosene
Biodiesel
Products
1. Total taxable sales . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2. Total taxable own use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3. Total taxable gallons (add lines 1 and 2 in each column) . . . . . . .
Summary of Motor Vehicle Fuel Tax
4. TOTAL GALLONS SUBJECT TO TAX (add line 3, columns 1, 2, and 3) . . . . . . . . .
.309
5. Motor Vehicle Fuel Tax Rate Per Gallon . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6. Motor Vehicle fuel Tax Due (line 4 multiplied by line 5) . . . . . . . . . . . . . . . . . . . . . . .
Summary of Petroleum Inspection Fee
7. Enter the total taxable biodiesel gallons from line 3, Column 2, above . . . . . . . . . . . . . .
8. Total gallons of non-taxable biodiesel used, blended, or sold for non-highway use in
mobile machinery and equipment not included above . . . . . . . . . . . . . . . . . . . . . . . . . . .
9. TOTAL GALLONS SUBJECT TO FEE (add lines 7 and 8) . . . . . . . . . . . . . . . . . . . . . . .
.02
10. Petroleum Inspection Fee per Gallon . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
11. Petroleum Inspection Fee due (multiply line 9 by 10) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
12. Total Tax and Fee due (add lines 6 and 11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
DECLARATION:
I declare under penalties of law that the above information is true, correct, and complete to the best of my knowledge and belief.
Signature (do not print or type)
Contact Person (please print clearly)
Telephone Number
Date
(
)
MF-017 (R. 1-12)
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Parent category: Financial