Form Mf-205 - Alcohol Fuel Tax Report

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MF-205: ALCOHOL FUEL TAX REPORT
Due on or before July 31.
Limited Manufacturer’s Permit #:
Check this box if there has been a change to
the business name, address, or ownership.
Legal Name (print or type)
FEIN or SSN (if sole proprietor)
Mailing Address - Street or PO Box
City
State
Zip Code
Read the instructions before completing this report.
July 1, 2011 thru
June 30
ALCOHOL USAGE AND INVENTORY RECONCILIATION
Gallons
1. Actual measured inventory at the beginning of the period
1.
2. Alcohol manufactured during the period
2.
3. Total alcohol available (add lines 1 and 2)
3.
4. Total alcohol gallons used in licensed motor vehicles
4.
5. Gallons disposed of or used for other purposes
Gallons
Describe Use
a.
b.
c.
d.
Subtotal (add lines 5a through 5d)
5.
6. Total gallons disposed of (add lines 4 and 5)
6.
7. Book inventory at end of the period (line 3 less line 6)
7.
8. Actual measured inventory at end of the period
8.
9. Difference (over) short (line 7 less line 8)
9.
TAX COMPUTATION
10. Motor vehicle fuel tax rate per gallon
10.
.309
11. Tax Due (multiply line 4 by line 10)
PAY WITH REPORT
$
DECLARATION: I declare to the best of my knowledge and belief that this is an accurate and true report of the number of gallons of ethyl
alcohol used by me as a fuel to power a licensed motor vehicle.
Date
Signature
Contact Person (please print clearly)
Telephone Number
(
)
MF-205 (R. 1-12)

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