Form L-2119 - Motor Fuel Suppliers Monthly User Fee And Fee Calculation
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12STATE OF SOUTH CAROLINA
L-2119
DEPARTMENT OF REVENUE
1350
MOTOR FUEL SUPPLIERS MONTHLY
USER FEE AND FEE CALCULATION
(Rev. 10/13/14)
4207
Mail to: South Carolina Department of Revenue, Motor Fuel, Columbia, SC 29214-0132.
SUPPLIER NAME AND ADDRESS
License Number
FEIN
Period Covered
USER FEE AND OTHER APPLICABLE FEE CALCULATIONS
1.
Gasoline User Fee Collected
2.
Less Tare Allowance
3.
Less Administration Allowance
4.
Less Credit
5.
Net Gasoline User Fee Due
6.
Penalty
7.
Interest
8.
Total Gasoline User Fee Due
34-2301
9.
Special Fuels User Fee Collected
10.
Less Tare Allowance
11.
Less Administration Allowance
12.
Less Credit
13.
Net Special Fuels User Fee Due
14.
Penalty
15.
Interest
34-2101
16.
Total Special Fuels User Fee Due
17.
Inspection Fees Collected
18.
Less Credit
19.
Penalty
20.
Interest
21.
Total Inspection Fees Due
34-2314
22.
Environmental Impact Fees Collected
23.
Less Credit
24.
Penalty
25.
Interest
26.
Total Environmental Impact Fees Due
34-2312
27.
Total Fees Due, Plus Penalty and Interest
(Add lines 8, 16, 21 and 26)
42071027
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Parent category: Financial