Fuel Supplier Tax Return (In-State And Out-Of-State) Page 2

Instructions

1. Total gallons withdrawn from pipeline(s) located within South Dakota (Attach Uniform Schedule of Disbursements -- Type 5)

2. Out-of-State Suppliers Only: Total gallons of fuel withdrawn from pipline(s) located outside of South Dakota with a South Dakota destination on the bill of lading (Attach Uniform Schedule of Disbursements -- Type 5)

3. Total Sales -- Add Lines 1 and 2

4. Total gallons withdrawn and sold to a U.S. governmental entity directly from the pipeline (Attach Uniform Schedule of Disbursements -- Type 8)

5. Total gallons withdrawn from pipeline(s) located inside South Dakota and sold to licensed exporters for an out-of-state destination (Attach Unifrom Schedule of Disbursements -- Type 6a)

6. Total gallons of 100% ethyl alcohol and 100% methyl alcohol previously taxed (Attach Uniform Schedule of Disbursements -- Type 5)

7. Total gallons of undyed K-1 kerosene sold for non-taxable purposes (Attach Uniform Schedule of Disbursements -- Type 10)

8. Total Credits -- Add Lines 4, 5, 6 and 7

9. Subtotal Taxable Gallons -- Subtract Line 8 from Line 3

10. Supplier Allowance of 2.25% (If filing on time) -- Multiply Line 9 by 0.0225

11. Total Taxable Gallons -- Subtract Line 10 from Line 9

12. Tax Rates

13. Taxes Due -- Multiply Line 11 by Line 12

14. Total All Taxes Due -- Add Columns A through J on Line 13

15. Total Gallons -- Add Columns A through J on Line 9

16. Total Gallons Sold to Governmental Entities -- Add Columns A through J on Line 4

17. Total Gallons of Undyed K-1 Kerosene --Column E on Line 7

18. Subtotal Tank Inspection Fee Gallons -- Add Lines 15, 16, and 17

19. Tank Inspection Fee -- Multiply Line 18 by $0.02

20. Total Taxes and Fees Due -- Add Line 14 and 19

21. Interest and Penalty (If filing after due date)

22. Balance Due or Credit from Prior Reporting Period (See Computer Notice)

23. Grand Total Add Lines 20 and 21, and add or subtract Line 22 (Depending on balance due or credit)