Fillable Form 86-002 - Retailers E85 Quarterly Report (Page 2 of 2) in pdf

Instructions for Retailers E85 Quarterly Report

86-002b (06/22/11)

Iowa Sales Tax Permit No.:

Beginning January 1, 2006, retailers of E85 gasoline

must file a report with the Department. Reports are

Enter the Iowa retail sales tax permit number for this

filed on a quarterly basis. The report is due on or

location. If the permit is part of a consolidated sales

before the last day of the month following the

tax permit, also provide the consolidated sales tax

calendar quarter covered by the report. A report must

permit number. If this location does not have a sales

be filed even if there is no E85 activity in Iowa

tax permit number, please explain.

during the quarter. A separate report is required for

each location that sells E85.

Iowa Weights and Measures No.:

Enter the Iowa license number issued by the Weights

The report must also include a listing of the vendors

and Measures Division of the Iowa Department of

providing E85 gasoline to the retailer and the

Agriculture for the pump(s) you have at this location

number of gallons received from each vendor. If the

Quarterly Report

retailer blends E85 gasoline, the retailer must show

the number of gallons of motor fuel (including both

gasoline and alcohol) purchased and blended.

Line 1:

Enter gross gallons of all ethanol blended gasoline

This report is in addition to the yearly report called

sold as E85. This includes gasoline blended with

Retailers Motor Fuel Gallons Annual Report, due

ethanol with a blend content of 70% - 85% ethanol.

end of January each year.

Line 2:

Quarter Ending and Due Date:

Enter the total of gross gallons purchased from

• January 1 to March 31: due April 30

schedule 86-003.

• April 1 to June 30: due July 31

• July 1 to September 30: due October 31

First Time Filer Start Date:

• October 1 to December 31: due January 31

If this is the first filing, what is your start date of

selling E85 at retail?

Mailing Address:

Enter the mailing address.

Type of File:

Check which one of the following applies:

Location Address

Non Blender – No blending at retail location.

E85 purchased as a blended product.

Enter the location address.

E85 Product blender - Retail location took two

County Name:

products and created a blended product E85.

Other - please explain.

Enter name of county in Iowa where the fuel is sold.

E-mail Address:

Social Security Number:

Write your e-mail address clearly. An e-mail will be

If the business is a sole proprietorship, enter the

sent each quarter as a reminder to complete this

Social Security Number of the owner.

form.

Federal Employer ID No.:

Web Site Forms

If the business is a partnership, corporation, or

limited liability company, enter the FEIN.

This form is on the Department’s Web site under

Forms > Motor Fuel at

forms/86002.pdf.

Form 86-002 - Retailers E85 Quarterly Report Page 2

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