Form 4515 - Alternative Fuels Inventory Report For End Users
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Michigan Department of Treasury
4615 (12-07)
Alternative Fuels Inventory Report for End Users
This form is issued under authority of P.A. 403 of 2000, as amended. Filing is mandatory. This form is to be filed by all end users with bulk storage of
diesel fuel that is a blend of at least 5% biodiesel and gasohol that is a blend containing 70% - 99% ethanol.
Due Date: January 22, 2008
TAXPAYER INFORMATION
Company Name and Address
Account Number (FEIN)
Contact Person Name
Phone Number
Fax Number
Email Address
If you do not have undyed biodiesel fuel that is at least 5% biodiesel or gasohol that is 70% - 99% ethanol in inventory
on December 31, 2007, check this box, sign below and return to the address at the bottom of this form.
INVENTORY REPORT
BIODIESEL
GASOHOL
Biodiesel will be identified below as B5 - B100 (B05-B00) and gasohol as E70 - E99.
1. Gallons of B5 - B100 biodiesel product(s) in storage as of December 31, 2007.
2. Gallons of E70 - E99 gasohol product(s) in storage as of December 31, 2007.
3. Inventory Allowance.
3,000
3,000
4. Taxable Gallons: Subtract 3000 gallons from the amounts in Lines 1 and 2 for both columns. If less than
zero, enter 0 and do not proceed.
$
5. Multiply line 4 in column 1 by $0.03. This is your Inventory Tax for Biodiesel.
6. Multiply line 4 in Column 2 by $0.07. This is your Inventory Tax for Gasohol.
$
$
7. Add lines 5 and 6. This is your total Inventory Tax. PAY THIS AMOUNT
CERTIFICATION
I authorize Treasury to discuss my return and attachments.
Do not discuss my return with my preparer.
Authorized Signature
Signature of Preparer
Printed Name
Printed Name
Date
Telephone Number
Preparer's FEIN
Telephone Number
Title
Address
Mail Report and Remittance to:
Make check payable to: "State of Michigan - Motor Fuel."
Michigan Department of Treasury
Write your account number on the front of your check.
Discovery & Tax Enforcement Division
P.O. Box 30140
Lansing, MI 48909-7640
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