Form Op-216 - Special Fuel Tax Return
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1
2
3Department of Revenue Services
Form OP-216
State of Connecticut
PO Box 5031
Special Fuel Tax Return
Hartford CT 06102-5031
Return for period ending
(Rev. 06/13)
Connecticut Tax Registration Number
Federal Employee Identifi cation Number (FEIN)
Due on or before
:
Please check if applicable
Out of business
Amended return
All Liquid Gallons
(Round off to the nearest gallon.)
Complete this return in blue or black ink only.
1
Opening physical inventory: Must agree with prior month’s closing inventory
1
.
2
Gallons purchased, state excise tax paid within Connecticut: Attach Form MF-R, Schedule 1.
2
3
Gallons purchased, state excise tax unpaid within Connecticut: Attach Form MF-R, Schedule 2
3
.
4
Gallons imported direct to customers within Connecticut: Attach Form MF-R, Schedule 3.
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5
Gallons imported into Connecticut storage: Attach Form MF-R, Schedule 4
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.
6
Gallons available for sale or use: Add Lines 1 through 5
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.
7
Closing physical inventory: Include in-transit items
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.
8
Total gallons to be accounted for: Subtract Line 7 from Line 6
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.
9
Nontaxable sales and transfers to licensed distributors: Attach Form MF-D, Schedule 6
9
.
Sales and transfers out of Connecticut and sales in Connecticut for immediate
10
10
export from Connecticut: Attach Form MF-D, Schedule 7.
11 Gallons sold to U.S. government tax exempt: Attach Form MF-D, Schedule 8
11
.
12 Gallons sold to state and local government tax exempt: Attach Form MF-D, Schedule 9
12
.
Sales to farmers or other tax exempt entities, nontaxable uses, sales of jet fuel, and sales of
13
13
#2 heating oil and kerosene for heating purposes: Attach Form MF-D, Schedule 10
.
14 Gain or loss from inventory variation: Show gain as negative and deduct.
14
15 Total nontaxable sales and uses: Add Lines 9 through 14
15
.
16 Taxable sales other than to licensed distributors
16
17 Taxable sales to licensed distributors: Attach Form MF-D, Schedule 5
17
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18 Taxable uses
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19 Total taxable sales and uses: Add Lines 16, 17, and 18
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.
20 Total gallons accounted for: Add Line 19 and Line 15; the sum must equal Line 8
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21 Deduct tax paid purchases.
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22 Deduct dealer sales to governmental entities: Attach Form MF-D, Schedule 13
22
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23 Total Deductions: Add Line 21 and Line 22
23
.
24a) Taxable diesel gallons
24b) Taxable alternative fuel gallons
24 Taxable Gallons: Subtract Line 23 from Line 19
24
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25 Tax Due: Multiply Line 24a by 54.9¢ per gallon and Line 24b by 26¢ per gallon.
25
.00
26 Penalty: 10% (.10) of total tax due or $50, whichever is greater
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.00
27 Interest: 1% (.01) per month or fraction of a month from due date to date of payment
27
.00
28 Total Amount Due: Add Lines 25, 26, and 27
28
.00
.
Please sign this return on the reverse side.
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