Form Alt - Licensed Alternate Fuels Dealer Or User Report

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Instructions
ALT
Licensed Alternate Fuels
Form
Dealer or User Report
Tax Account Number
Wisconsin
Department of Revenue
FEIN / SSN
Month Covered (MM DD YYYY)
Legal Name
Use BLACK INK Only
Cancel my permit effective
Business Name (DBA)
(MM DD YYYY)
Permit/Business Address
Check if address, name, or entity
change
City
State
Zip Code
Check if this is an amended return
Check if correspondence is included
OTHER
CNG
LPG
SUBMIT THIS REPORT EVEN IF YOU DO NOT OWE ANY TAX
(liquefied propane)
Describe:
(natural gas)
1. Total taxable sales
ENTER AMOUNTS IN
WHOLE GALLONS
2. Total taxable own use
3. Total taxable gallons (add lines 1 and 2 in each column)
4. Tax rate per gallon
.247
.226
.309
5. Tax due per type of alternate fuel (multiply line 3 by 4 in
each column)
6. TOTAL ALTERNATE FUEL TAX DUE (add tax amounts
PAY THIS AMOUNT
$
in each column on line 5 and enter total here)
WITH YOUR REPORT
EFT
Check this box if you are paying the tax due on line 6 by
Payment
electronic funds transfer (EFT).
Make your check payable and mail to:
Wisconsin Department of Revenue
PO Box 8900
Madison WI 53708-8900
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-007 (N. 8-11)

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