Form L-2129 - Amended Motor Fuel Calculation Page
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2L-2129
STATE OF SOUTH CAROLINA
DEPARTMENT OF REVENUE
(Rev. 9/15/04)
AMENDED MOTOR FUEL CALCULATION PAGE
4218
Mail to: South Carolina Department of Revenue, Motor Fuel Reports, Columbia, SC 29214-0132.
Company Name
File Number
Period Covered
LOW SULFUR
LOW SULFUR
AVIATION
BLEND
DYED/HIGH
ADJUSTMENT
GASOLINE
KEROSENE
JET FUEL
DIESEL
GASOLINE
COMPONENTS
SULFUR DIESEL
1.
Diversion Correction
2.
Gallons Received User Fee Paid
3.
Gallons Removed Free of User Fee
For Import by Licensed Importer
4.
Export (User Fee Collected)
5.
Export (User Fee Exempt)
6.
Total Export
7.
US Government Sales
8.
SC Department of Education School Bus
9.
Aviation Use
10.
Other Exempt Sales
11.
Total Exempt Sales
12.
Dyed Fuels
13.
Total Exempt From State User Fee
14.
Sale Subject to User Fee - (Non-eligible)
15.
Sale Subject to User Fee - (Eligible)
16.
User Fee Paid by Importer
17.
User Fee Paid by Exporter
18.
Total SC User Fee Paid
19.
Total Gallons Subject to User Fee
20.
Total Gallons Removed
GASOLINE
SPECIAL FUEL
INSPECTION
ENVIRONMENTAL
21.
User Fee Liability
22.
Tare Allowance
23.
Admin. Allowance
24.
Net User Fee Liability
25.
Payments
26.
User Fee Due - (Credit)
27.
Penalty
28.
Interest
Total for Return
29.
Total User Fee Due With Notice
To assist in the calculation of penalty and interest, please visit our website at If you need any information please contact this office (803)
898-5743.
Name:
Signature:
Date:
(Print)
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