Form L-2117 - Tare Allowance Refund Application

Download a blank fillable Form L-2117 - Tare Allowance Refund Application in PDF format just by clicking the "DOWNLOAD PDF" button.

Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.

Complete Form L-2117 - Tare Allowance Refund Application with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.

Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.

ADVERTISEMENT

1350
1350
STATE OF SOUTH CAROLINA
L-2117
DEPARTMENT OF REVENUE
(Rev. 12/20/07)
TARE ALLOWANCE REFUND APPLICATION
4205
Mail to: South Carolina Department of Revenue, Motor Fuel, Columbia, SC 29214-0139.
Fuel Vendor License Number
FUEL VENDOR NAME
ADDRESS
FEI Number
Quarter Ending
UNDYED
GASOLINE
FIRST MONTH
DIESEL
*
1.
Total User Fee Paid Gallons Received
2.
Amount of User Fee Paid (Line 1 x $.16)
3.
Amount of Tare Allowance Refund Due For Month
(Line 2 x $.0265) Not To Exceed $2000.00
UNDYED
GASOLINE
SECOND MONTH
DIESEL
*
1.
Total User Fee Paid Gallons Received
2.
Amount of User Fee Paid (Line 1 x $.16)
3.
Amount of Tare Allowance Refund Due For Month
(Line 2 x $.0265) Not To Exceed $2000.00
UNDYED
GASOLINE
THIRD MONTH
DIESEL
*
1.
Total User Fee Paid Gallons Received
2.
Amount of User Fee Paid (Line 1 x $.16)
3.
Amount of Tare Allowance Refund Due For Month
(Line 2 x $.0265) Not To Exceed $2000.00
Total Refund Due By Product Type (The Sum Of
4.
Line 3 For All Three Months)
34-2301
34-2101
*
If you export product from South Carolina bulk storage, see special instructions on the back.
Under penalties of perjury, I hereby certify that the information provided with my request (including all
attachments) has been examined by me and to the best of my knowledge, is true, correct and complete.
Name:
Signature:
(Print)
Phone Number:
Date:
DO NOT USE THIS SPACE
Audited By
Date
42051011

ADVERTISEMENT

00 votes

Related Articles

Top 20 Happy Easter Cards And Gift Tags To Download For Free
Top Ten Easter Arts And Crafts Activities For Your Kids
Free Easter Coloring Pages And Easter Printables For Your Kids

Related forms

Form L-2133 - Motor Fuel Refund Application Form L-2133 - Motor Fuel Refund Application Financial
Form Fms 210 - Vehicle Registration Refund Application Form Fms 210 - Vehicle Registration Refund Application Legal
Form Mv347 - Document Fee Credit/refund Application Form Mv347 - Document Fee Credit/refund Application Legal
Form Sft-9 - Special Fuels Refund Application Form Sft-9 - Special Fuels Refund Application Financial
Form 72a006 - Motor Fuel Tax Refund Application Form 72a006 - Motor Fuel Tax Refund Application Financial
Form Mfa-20 - Motor Fuels Refund Application Form Mfa-20 - Motor Fuels Refund Application Financial
Form Rt-123 - Road Toll Refund Application Form Rt-123 - Road Toll Refund Application Legal
Form 72a006 - Motor Fuel Tax Refund Application Form 72a006 - Motor Fuel Tax Refund Application Financial
Form Gt-9m - Gasoline Tax Refund Application Form Gt-9m - Gasoline Tax Refund Application Financial
Form Mfa-20 - Motor Fuels Refund Application Form Mfa-20 - Motor Fuels Refund Application Financial

Related Categories

Parent category: Financial
Download
Go
Page of 5