Form Pt-200 - Quarterly Petroleum Business Tax Return
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1
2PT-200
For office use only
Department of Taxation and Finance
Q415
Quarterly Petroleum
(11/15)
Business Tax Return
(Retailer of Non-Highway Diesel Motor Fuel Only
and Distributor of Kero-Jet Fuel Only)
Tax Law – Articles 12-A and 13-A
Use this form to report transactions for the quarterly period September 1, 2015, through November 30, 2015.
You must file this return by December 21, 2015.
Federal employer identification number (EIN)
Business telephone number
Change of business
information – You can
(
)
update your address and
Legal name
other business information
by visiting our Web site
(see Need help?). Select
DBA
the option to change
your address for further
Street
instructions. For more
information, see Change of
business information.
City, state, ZIP code
Monthly filers must use Form PT-100, and Form PT-106 or Form PT-104. Read instructions on page 2 carefully. Keep a copy for your records.
Payment – Attach your check or money order payable in U.S. funds to: Commissioner of Taxation and Finance.
Payment enclosed
NYS Tax Department, PO Box 1833, Albany NY 12201-1833
Mail to:
Type of filer -
Mark an X in the appropriate box. You must submit the appropriate attachments for each box marked.
Totals
Retailers of non-highway diesel motor fuel only
(registered as a retailer of non-highway diesel motor
1
fuel only)
...........................................................................................................
1
(from Form PT-201, line 28)
Tax on kero-jet fuel
(registered as a distributor of kero-jet fuel only)
2
2
(from Form PT-202, line 17)
.........................
3 Subtotal of tax due
..............................................................................................
3
(amount from line 1 or line 2)
4 Credits from prior quarterly return .................................................................................................................
4
5 Balance due
5
(subtract line 4 from line 3; if an overpayment enter 0 and enter the overpayment amount on line 9 below)
6 Penalties
..............................................................................................................................
6
(see instructions)
7 Interest
.................................................................................................................................
7
(see instructions)
8 Total amount due
..........................................................................................................
8
(add lines 5, 6, and 7)
9
9 Overpayment
.....................................................................................................
(see line 5)
10 Amount to be credited to next quarterly return ........................................................... 10
11 Amount to be refunded............................................................................................... 11
I am a sales tax exempt organization and not subject to the Article 13-A tax on petroleum businesses
.
(see instructions)
My exemption number is
.
I certify that this business is duly registered to deal in the product that is being reported and that this return, including any
accompanying riders, is to the best of my knowledge and belief true, correct, and complete.
Signature of authorized person
Official title
Authorized
person
E-mail address of authorized person
Date
Firm’s EIN
Preparer’s PTIN or SSN
Paid
Firm’s name
(or yours if self-employed)
preparer
Signature of individual preparing this return
Address
City
State
ZIP code
use
only
E-mail address of individual preparing this return
Preparer’s NYTPRIN
Date
(see instr.)
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