Fuel Supplier Tax Return (In-State And Out-Of-State)
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1
2Fuel Supplier Tax Return (In-State and Out-of-State)
Pipeline Reporting
Mail
Remittance Center
Return to:
P.O. Box 5055
Sioux Falls, SD 57117-5055
Check here if this is an amended return
Report in Whole Gross Gallons Only
(Pipeline reporting only. This return is not for reporting own truck transports or rail movement.)
Column A
Column B
Column C
Column D
Column E
Column F
Column G
Column H
Column I
Column J
SALES
*Instructions on Back of Return
Gasoline
100% Ethyl
AVGAS
Dyed Diesel
Undyed Diesel
Jet
Dyed Bio-Diesel
Undyed Bio-Diesel
100% Methyl
Other /Natural
Alcohol
& Kerosene
& Kerosene
Fuel
Blend
Blend
Alcohol
Gasoline
1
1
Withdrawn from SD Pipeline
2
2
Withdrawn from Out-of-state Pipeline
3
3
Total Sales -- Add Lines 1 and 2
CREDITS
4
4
Sold to US Government
5
5
Sold to Licensed Exporter
6
6
Ethyl Alcohol & Methyl Alcohol
7
7
Undyed K-1 Kerosene
8
8
Total Credits -- Add lines 4, 5, 6, and 7
TAX COMPUTATION
Subtotal Taxable Gallons -- Subtract
9
9
Line 8 from Line 3
Allowance (If filing on time) --
10
10
Multiply Line 9 by 0.0225
Total Taxable Gallons -- Subtract Line
11
11
10 from Line 9
X $0.22
X $0.08
X $0.06
X $0.00
X $0.22
X $0.04
X $0.00
X $0.22
X $0.08
X $0.22
12
12
Tax Rates
13
$
$
$
$
$
$
$
$
13
Taxes Due -Multiply Line 11 by Line 12
Total All Taxes Due -- Add Columns A
14
14
$
Through J on Line 13
TANK INSPECTION FEE
TAXES AND FEES DUE
$
15
20
20
15
Total Gallons -- Add Columns A through J on Line 9
Total Taxes and Fees Due -- Add Line 14 and 19
$
Total Gallons Sold to Governmental Entities -- Add Columns A
21
21
16
16
Interest and Penalty (If filing after due date)
through J on Line 4
$
22
22
17
17
Balance Due or Credit From Prior Reporting Period (See Computer Notice)
Total Gallons of Undyed K-1 Kerosene -- Column E on Line 7
23
23
$
Grand Total -- Add Lines 20 and 21, and add or subtract line 22 (Depending on balance due or credit)
18
18
Subtotal Tank Inspection Fee Gallons -- Add Line 15, 16, and 17
I declare and affirm under penalty of perjury that this report has been examined by me, and to the best of my knowledge and belief is in all things true and correct.
$
19
Tank Inspection Fee -- Multiply Line 18 by $0.02
19
Check if final return and
Signature
Title
Date
1
(7-09)
license is to be cancelled
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