General Instructions Form 9114w

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DELAWARE DIVISION OF REVENUE
GENERAL INSTRUCTIONS
FORM 9114W
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House Bill 234 of the 144
General Assembly amended Title 7 Chapter 91 to ensure that the tax surcharge
imposed by the Hazardous Substance Cleanup Act (HSCA) is paid only once, regardless of how many times
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petroleum products are resold for all petroleum gross receipts received after June 30
2007. Complete this
Petroleum Wholesale Form 9114W and attach it to your gross receipts tax return to report all petroleum
purchases that the HSCA tax has already been paid.
SPECIFIC INSTRUCTIONS FORM 9114W
LINE 1: Enter on line 1 either your federal employer identification number or your social security number.
LINE 2: Enter on line 2 the name of your company or business.
LINE 3: Enter on line 3 the address of your company or business.
LINE 4: Enter on line 4(a) the month for which you are claming previous payments of the HSCA tax. Enter on
line 4(b) the total petroleum monthly gross receipts from line 5 of your gross receipts tax return. Note this
amount cannot be less than what is entered on line 5 of your gross receipts tax return.
LINE 5: Enter on line 5 the name and address of all petroleum distributors and wholesalers that you purchased
petroleum products from in the month.
LINE 5(a): Enter the distributor or wholesaler’s federal employer identification number and Delaware business
license number.
LINE 5(b): Enter the total amount of petroleum products purchased excluding the HSCA tax from the
distributor or wholesaler.
LINE 5(c): Enter the total amount, if any, of HSCA tax paid on the amount listed on line 5(b). If petroleum
products were purchased from a Delaware Petroleum Wholesaler that remitted and/or collected HSCA tax
multiply line 5(b) times 0.009. NOTE you must be able to substantiate any amount of tax payment claimed on
line 5(c). Failure to substantiate an amount, if requested, will result in you being liable for the tax as well as
statutory penalties and interest.
LINE 6: Enter on line 6(b) the total of all petroleum products purchased in the month from Form 9114W and
Form 9114W Supplemental Line 5 (if used). Enter on line 6(c) the total of all HSCA tax paid in the month from
Form 9114W and Form 9114W Supplemental Line 5 (if used).
LINE 7: Multiply line 6(b) by 0.009 and round the result to the forth decimal place (i.e. 0.75265 = 0.7527). Enter
the result on line 7.
LINE 8: Divide line 6(c) by the amount on line 7 and round the result to the forth decimal place (i.e. 0.75265 =
0.7527). Enter the result on line 8.
LINE 9: Subtract line 8 from 1.0 and round the result to the forth decimal place (i.e. 0.75265 = 0.7527). Enter
the result on line 9.
LINE 10: Multiply line 4(b) by line 9. Multiply the result by 0.009 and round the result to the fourth decimal
place (i.e. 0.75265 = 0.7527). Enter the result on line 6 of your petroleum gross receipts tax return.
(Revised 08/07/07)

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