Form R-5397 - Supplier/permissive Supplier Monthly Return Page 2
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2R-5397 (7/06)
__________________________
Supplier/Permissive Supplier Return – Page 2
Revenue Account Number
All applicable schedules must be completed and attached.
B
C
D
E
A
Undyed
Dyed
Aviation
Reportable Gallons
Gasohol
Gasoline
Diesel Fuels
Diesel Fuels
Fuels
All gallons sold/ removed at terminal rack for
15
unlicensed customers (Sch. C – R-5401)
All gallons removed at terminal rack
16
for LA licensees (Sch. C – R-5401)
Gallons imported/purchased outside the
17
bulk transfer/terminal system with LA
tax and inspection fee paid (Sch. A – R-5291)
Gallons imported/purchased outside
18
the bulk transfer/terminal system with
only inspection fee paid (Sch. A – R-5291)
Gallons imported/purchased outside the bulk
19
transfer/terminal system with no LA tax or
inspection fee paid (Sch. A – R-5291)
20
Gallons removed for own use (Sch. C – R-5401)
Diversions into LA with no LA tax
21
and/or fee paid (Sch. D – R-5402)
22
Other
23
Total (Add Lines 15 through 22.)
Nontaxable Removals Subject to Inspection Fee Only
Gallons removed and sold directly to U.S. gov-
24
ernment (See instructions) (Sch. C – R-5401)
Dyed diesel and dyed kerosene gallons
25
removed for non-highway purposes
(Sch. C – R-5401)
Aviation fuels removed/sold for aviation
26
purposes (Sch. C – R-5401)
27
Other
28
Total (Add Lines 24 through 27.)
Nontaxable Removals Not Subject to Inspection Fee
Gallons removed for export with destination
29
state tax collected (Sch. C – R-5401)
Diesel fuel removed for exempt
30
seagoing vessels (Sch. C – R-5401)
31
Diversions out of LA (Sch. D – R-5402)
32
Other
33
Total (Add Lines 29 through 32.)
Calculations of Taxable Gallons
Total reportable gallons
34
(Amount from Line 23)
Non-taxable Removals
35
(Total of Lines 28 and 33)
Net reportable gallons
36
(Subtract Line 35 from Line 34.)
37
Tax-paid purchases (Sch. A – R-5291)
Net gallons subject to tax (Subtract Line 37
38
from Line 36. Enter on Page 1, Line 1.)
Computation of Gallons Subject to Inspection Fee
Total gallons subject to inspection fee
39
(Subtract Line 33 from Line 23.)
Inspection fee – paid purchases
40
(Sch. A – R-5291)
Net gallons subject to inspection fee
41
(Subtract Line 40 from Line 39. Enter on
Page 1, Line 8.)
7642
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