Form Tc-922a - Schedule A - Bulk Fuel Reporting And Sales Tax Due On Undyed Diesel Fuel

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Schedule A - Bulk Fuel Reporting and
TC-922A
92283
Sales Tax Due on Undyed Diesel Fuel
Rev. 12/08
IFTA/SFU account number
Tax period (mmddyyyy)
Taxpayer name
UT-
(a)
(b)
(c)
Part A - Calculate Undyed Diesel Fuel Dispensed
Utah Gallons
Non-Utah Gallons
Total Gallons
1
1. Beginning undyed
bulk
fuel inventory
2
2. Undyed fuel purchased in bulk
3
3. Ending undyed bulk fuel inventory
4
4. Undyed bulk fuel dispensed from inventory (add lines 1 and 2, subtract line 3)
5
5. Undyed fuel purchased at service stations (non-bulk)
6
6. Total undyed fuel dispensed (add lines 4 and 5)
(a)
(b)
(c)
Part B - Categorized Undyed Diesel Fuel Dispensed
Utah Gallons
Non-Utah Gallons
Total Gallons
7
7. Total undyed fuel dispensed into Utah IFTA fleet
8
NA
8. Total undyed fuel dispensed into Utah Special Fuel User fleet
9
9. Total undyed fuel dispensed into machinery, equipment, reefers, etc.
10
10. Sales of undyed fuel to third parties and other adjustments (attach explanation)
11
11. Total undyed fuel dispensed (add lines 7 through 10) - This should equal line 6
(b)
(c)
(a)
Categorized Utah Undyed Diesel Fuel Consumed
Subject to Utah
Exempt from Utah
Part C -
Total Gallons
for Non-highway purposes
Sales & Use Tax
Sales & Use Tax
12
Gallons consumed in Utah off-highway travel, computed from the Utah line of the
12.
IFTA return (taxable Utah miles subtracted from Utah total miles, divided by MPG)
13
13. Utah PTO gallons from Schedule B, line 31
14
Utah non-highway gallons from Schedule B, line 30 (undyed fuel dispensed into
14.
machinery, equipment, reefers, etc.)
15
15. Total gallons (add lines 12, 13 & 14)
Statement of Exemption
22.
(a)
Part D - Calculate Utah Sales and Use Tax Due
Utah Only
I certify that the fuel claimed on
line 15b, above:
16
16. Undyed diesel fuel purchased in Utah (add lines 2a and 5a)
Was used in a qualified
manufacturing process
17
Amount paid, excluding state and federal excise tax, for undyed diesel fuel
17.
$
purchased in Utah (for gallons shown on line 16)
Other (please explain)
18
18. Average price per gallon (line 17 divided by line 16)
$
19
Amount paid for fuel subject to sales and use tax in Utah (multiply line 15(a) by line 18)
19.
If reporting sales & use tax due on your Sales & Use Tax Return, include this amount (line 19)
$
on your Sales &Use Tax return. Enter your sales & use tax account number below.
20
%
20. Sales tax rate - see instructions
21
Sales and use tax due (multiply line 19 by line 20). Enter this amount on line 9 of form
21.
$
TC-922, OR report amount on your sales and use tax return.
Sales & use tax account number
Authorized signature
X
Utah State Tax Commission, 210 N 1950 W, Salt Lake City, Utah 84134

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