Form 105-50 - Fuel Blender Tax Calculation
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1
2Form Number 105-50
Revised 9-04
State of Oklahoma
State of Oklahoma
State of Oklahoma
State of Oklahoma
State of Oklahoma
Oklahoma Tax Commission
Oklahoma Tax Commission
Oklahoma Tax Commission
Oklahoma Tax Commission
Oklahoma Tax Commission
Fuel Blender Tax Calculation
Fuel Blender Tax Calculation
Fuel Blender Tax Calculation
Fuel Blender Tax Calculation
Fuel Blender Tax Calculation
Instructions on Back
Mail To:
Oklahoma Tax Commission
dst - 220
dst - 220
dst - 220
dst - 220
dst - 220
Audit Division - Motor Fuel Section
2501 North Lincoln Boulevard
(5/04)
(5/04)
(5/04)
Oklahoma City, OK 73194
(5/04)
(5/04)
name, address, and phone number
fei number
period covered
Tax Calculation
Total Tax-Paid Gallons Received
1
(Enter Total from Tax-Paid Receipts Schedule 1)
2
Total Gallons of Product Blended with Gasoline
3
Total Gallons of Product Blended with Diesel
4
Net Taxable Gallons
(Enter Total from Receipts Schedule 2B)
5
Net Gasoline Tax Due (Line 2 X $0.16)
6
Penalty
(10% of Total Tax if not paid within 15 days from the due date)
7
Interest
(1.25% of Total Tax per month from the due date)
8
Total Gasoline Tax Due (Line 5 + Line 6 + Line 7)
MFG
9
Net Diesel Tax Due (Line 3 X $0.13)
10
Penalty
(10% of Total Tax if not paid within 15 days for the due date)
11
Interest
(1.25% of Total Tax per month from the due date)
12
Total Diesel Tax Due (Line 9 + Line 10 + Line 11)
MFD
Total Taxes Due (Total Lines 8 and 12)
13
Official Title
Signature
I/We declare under the penalty of perjury that this return including any accompanying schedules and statements has been
examined by me/us and to the best of my/our knowledge and belief is a true, correct and complete return made in good
faith for the taxable period stated, pursuant to existing laws requiring the filing of this return.
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