Clear Form
FORM
THIS SPACE FOR DATE RECEIVED STAMP
STATE OF HAWAII — DEPARTMENT OF TAXATION
M-20A
MONTHLY RETURN OF LIQUID FUEL TAX (STATE AND COUNTY)
AND ENVIRONMENTAL RESPONSE, ENERGY,
(REV. 2015)
AND FOOD SECURITY TAX
TO BE FILED BY DISTRIBUTOR
IF APPLICABLE, CHECK BOX:
Initial Return
Amended Return
FBF151
Final Return
Change in Name or Address
Name of Distributor
Federal Employer I.D. No or Social Security No.
DBA or C/O
Hawaii Tax I.D. No.
W
__ __ __ __ __ __ __ __ - __ __
Address (Number and Street)
Permit Number
City or town, State, and Postal/ZIP code. If foreign address, see Instructions.
Month Ending
___ ___ / ___ ___ (MM/YY)
This return with payment must be submitted to the Department of Taxation on or before the 20th day of the month following the close of the filing period.
NOTE:
PART I — COMPUTATION OF FUEL TAX AND ENVIRONMENTAL RESPONSE, ENERGY, AND FOOD SECURITY TAX
(a)
(b)
(c)
(d)
(e) Add cols. a to d
LIQUID FUEL CLASSIFICATION
CITY & COUNTY
COUNTY OF MAUI
COUNTY OF
COUNTY OF
TOTAL OF ALL
OF HONOLULU
(Use Part II Summary)
HAWAII
KAUAI
COUNTIES
On Highway Diesel Oil and Liquid Fuel
1.
Diesel - On Hwy.
Gals.
1
2.
Gasoline & Other Liquid Fuel
Gals.
2
3. Total (Add lines 1 and 2)
Gals.
3
4.
Tax Rate
33.5¢
35¢
b
25.8¢
34¢
Total tax for On Highway Diesel Oil and Liquid Fuel
5.
5
On Highway Alternative Fuel
6.
Biodiesel - On Hwy.
Gals.
6
b
7.
Tax Rate
12.3¢
13¢
4¢
4¢
8. Total tax for On Highway Biodiesel
8
Compressed Natural Gas (CNG) - On Hwy.
9.
Gals.
9
e
b,e
e
e
10.
Tax Rate
12.2¢
12.9¢
8.4¢
12.4¢
11. Total tax for On Highway CNG
11
12. Ethanol - On Hwy.
Gals.
12
b
13.
Tax Rate
4.8¢
6.6¢
3.7¢
4.9¢
14. Total tax for On Highway Ethanol
14
Liquefied Natural Gas (LNG) - On Hwy.
15.
Gals.
15
d
b,d
d
d
16.
Tax Rate
12.2¢
12.9¢
8.4¢
12.4¢
17. Total tax for On Highway LNG
17
18. LPG - On Hwy.
Gals.
18
19.
Tax Rate
10.6¢
9.9¢
b
8.1¢
10.8¢
20. Total tax for On Highway LPG
20
21. Methanol - On Hwy.
Gals.
21
22.
Tax Rate
3.7¢
5.1¢
b
2.9¢
3.8¢
23. Total tax for On Highway Methanol
23
24. Other Alternative Fuel
Gals.
24
(See Instr.)
25. Tax Rate (See Instructions)
26.
26
Total tax for other On Highway Alternative Fuel
Continue on page 2
DECLARATION
I declare, under the penalties set forth in section 231-36, HRS, that this is a true, correct, and complete return, prepared in accordance with the provisions of chapter 243,
HRS, the Fuel Tax Law, and chapter 18-243, HAR.
(
)
Signature
Type or Print Name and Title
Date
Daytime Phone Number
FORM M-20A