Form 73 - Nebraska Monthly Fuels Tax Return - 2012

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DO NOT FILE THIS FORM; MUST BE ELECTRONICALLY FILED
Nebraska Monthly Fuels Tax Return
FORM 73
Taxpayer Name
FEIN
NE ID Number
Tax Period
Sample Oil Company
123456789
009876543
07/2012
(A)
(B)
(C)
(D)
(E)
(F)
(G)
(H)
Compressed
Gasoline/
Undyed
Undyed or
Dyed Diesel/
Propane
Natural Gas
Aviation
Aviation Jet
Gasohol/
Diesel/
Dyed
Biodiesel
(LPG)
(CNG) or
Gasoline
Fuel
Ethanol
Biodiesel
Kerosene
Other
I. RECEIPTS (Gross Gallons)
1.
Tax-paid gallons, total of MFR Schedule Code 1
2.
Tax-free gallons (without PRF), total of MFR Schedule Codes 2 and 3
4,000
6,500
7,000
II. DISBURSEMENTS (Gross Gallons)
3.
Tax-paid gallons, total of MFD Schedule Code 5
4,000
2,000
7,000
4.
Other gallons disbursed tax-paid, used in a taxable manner, or blended with undyed diesel
500
550
5.
Gallons of biodiesel or kerosene blended with dyed diesel
100
6.
Tax-free gallons (without PRF), total of MFD Schedule Codes 6, 7, & 8
7.
Tax-free gallons sold to Native Americans, total of MFD Schedule Code 10
8.
Gallons disbursed tax-free pursuant to a Form 91EX
1,948
9.
Credit gallons supported by MFD Schedule Codes 13C and 13J
500
300
III. TAX COMPUTATION
10.
Gallons subject to tax:
Columns A, B, G, & H (line 2 minus lines 5, 6, 7, 8, & 9)
Column D (line 3 plus line 4)
Columns E & F (from line 4)
3,500
4,252
500
550
0
7,000
0
11.
Tax rate
0.267
0.267
0.267
0.267
0.267
0.050
0.030
12.
Gross tax due by fuel type (line 10 multiplied by line 11)
$935
$1,135
$134
$147
$0
$350
$0
13.
Gross tax due for motor vehicle fuels (line 12, column A); diesel fuel (line 12, total of columns B & D);
compressed fuel (line 12, total of columns E & F); & aircraft fuels (line 12, total of columns G & H)
$935
$1,269
$147
$350
14.
Commissions allowed:
Columns A & G (.0500 on first $5,000 plus .0250 on excess over $5,000)
Columns B & E (.0200 on first $5,000 plus .0050 on excess over $5,000)
$47
$25
$3
$18
15.
Net tax due (line 13 minus line 14)
$888
$1,244
$144
$332
IV. PETROLEUM RELEASE REMEDIAL ACTION FEE
16.
Gallons subject to fee:
Columns A, B, D, G, & H (line 10 plus lines 5, 7, 8, & 9)
Column C (line 2 minus line 6)
4,000
6,500
0
600
7,000
0
17.
Fee rate
0.009
0.003
0.003
0.003
0.009
0.003
18.
Total fee due (line 16 multiplied by line 17)
$36
$20
$0
$2
$63
$0
SUMMARY OF MOTOR FUEL TAXES AND FEES DUE
19.
Net tax due – motor fuels, line 15, columns A and B
$2,132
20.
Net tax due - compressed fuels, line 15, column E
$144
21.
Net tax due – aircraft fuels, line 15, column G
$332
22.
Petroleum Release Remedial Action Fee, line 18, column A through column H
$121
$2,729
23.
Total taxes and fees due (total of lines 19 through 22)

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