Rev. 4/02
Massachusetts
JFT-4S
Department of
Aircraft (Jet) Fuel Supplier Tax Return
Revenue
Jet fuel license number
Month
Year
Name of licensee
Federal Identification number
Address of licensee
City/Town
State
Zip
Address where records are kept (if different from above)
Name of authorized contact person
Telephone
Address of authorized contact person (if different from above)
City/Town
State
Zip
Inventories and Receipts
Use whole gallons only
11 Opening inventory . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 1
12 Receipts (from Schedule A). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 2
13 Total available gallons. Add lines 1 and 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
14 Closing inventory . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 4
15 Total gallons to be accounted. Subtract line 4 from line 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Distribution and Tax Computation
16 Nontaxable gallons sold and/or used (from Schedule B) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 6
17 Net taxable gallons aircraft (jet) fuel sold or used (from Schedule C) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 7
18 Total tax due. Multiply line 7 by tax at ________________ per gallon . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 8
19 Interest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 9
10 Penalty for late filing and/or late payment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 10
11 Total amount due. Add lines 8 through 10 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 11
Declaration
Under the penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best
of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which
he/she has knowledge.
Authorized signature
Title (owner, etc.)
Date
Make check payable to Commonwealth of Massachusetts. Mail to: Massachusetts Department of Revenue, PO Box 7012, Boston, MA 02204. Return
must be filed not later than the 20th day of the month following the month for which this return is made.
Tax Type 0160 Form Code: 676