Form L-2105 - Motor Fuel Bonded Importers Monthly Return Page 2
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1
2
3
4
5
6
7
8
9
10CALCULATION PAGE
Gasoline/
Undyed Diesel/
Undyed/Dyed
Dyed
Aviation
Other/
Description
Sch
Gasohol
Biodiesel
Fuel
Kerosene
Gasoline
Jet Fuel
Substitute Fuel
1
Gallons Received User Fee - Other Applicable
1-A
Fees Paid
2
Gallons Imported SC User Fee - Other
3
Applicable Fees Free
CALC
3
Total Gallons Received (Line 1 + Line 2)
6-F
4
Gallons Sold - Dyed Fuel
8
5
Gallons Sold to US Government
9-C
6
Gallons Sold to SC Dept of Educ. School Buses
10
7
Gallons Sold - Other Exempt Sales
8
Total Gallons Sold - Exempt From User Fee
CALC
(Lines 4, 5, 6 and 7)
9
Gallons Sold Subject to User Fee
CALC
(Line 3 - Line 8)
10
Net Gallons Sold Subject to User Fee
CALC
(Line 9 - Line 1)
11
Total Gallons Subject to Other Applicable Fees
CALC
(Line 2 - Line 5)
CALC
12
Motor Fuel User Fee Due (Line 10 x $0.16)
13
Gallons Sold Subject to User Fee -
5-A
Non-Eligible Purchaser
14
Gallons Sold Subject to User Fee -
5-C
Eligible Purchaser
CALC
15
Tare Allowance (Line 13 x 0.00424)
Penalties - Failure to file a return will result in a penalty of five percent (5%) for the first month plus five percent (5%) for each additional month not to exceed a total of
twenty-five percent (25%). Failure to pay will result in penalties of one half of one percent (.5%) per month not to exceed twenty-five percent (25%). Other penalties may
apply.
Interest - Interest on all overdue accounts will be assessed at the rate provided under Sections 6621 and 6622 of the Internal Revenue Code. Rates will change quarterly
depending on the prime rate. In addition, interest will be compounded daily.
I hereby certify that the information contained in this return (including all attachments) has been examined by me and to the best of my knowledge, is true, correct and a
complete return.
Name:
Signature:
Phone:
Date:
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