Fillable Form Wv/mft-505 - West Virginia Motor Fuel Blender Report printable pdf download

Form Wv/mft-505 - West Virginia Motor Fuel Blender Report

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STATE OF WEST VIRGINIA

State Tax Department, Tax Account Administration Div

P.O. Box 2991

Charleston, WV 25330-2991

Name

Address

Account #:

City

State

Zip

WV/MFT-505

WEST VIRGINIA MOTOR FUEL BLENDER REPORT

rtL154 v 5-Web

Effective January 1, 2013, the motor fuel excise tax rate increased from 33.4 cents per gallon to 34.7 cents per gallon. Returns

and refund applications have been updated. Please use the correct rate for periods after January 1, 2013.

This report and all required schedules must be completed and filed by the due date regardless of activity

You must keep a copy of this report for your records

Period Ending:

Due Date:

FINAL

AMENDED

TAX CALCULATION

(Complete Worksheets on Reverse Side of Report First)

Amount Due on Blended Products (Line 5 from Worksheet C)

Amount of Fully Tax-Paid Receipts (Line 1 from Worksheet C)

Amount of Variable Rate Tax-Paid Receipts (Line 2 from Worksheet C)

Balance of Tax Due (Line 1 minus Lines 2 and 3)

NON-WAIVABLE INTEREST

*ADDITIONS TO TAX (5% per month, not to exceed 25%; if no tax due $50 per month)

TOTAL TAX AND LATE FILING CHARGES DUE (Add Lines 4 through 6)

In addition to interest, a penalty of 5% per month (not to exceed 25%) is imposed if the return is late. Multiply Line 4 by 0.05 by the number of

months late. If no tax is due, a late filing penalty of $50 per month for each month or part of a month after the due date must be remitted.

Sign your return

Under penalties of perjury, I declare that I have examined this return (including accompanying schedules and statements) and to the best of my knowledge

and belief it is true and complete.

(Signature of Taxpayer)

(Name of Taxpayer - Type or Print)

(Title)

(Date)

(Person to Contact Concerning this Return)

(Telephone Number)

(Email Address)

(Signature of preparer other than taxpayer)

(Address)

(Date)

MAIL TO: WEST VIRGINIA STATE TAX DEPARTMENT