Form 4334 - Motor Fuel Untaxed Products Return
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1
2Michigan Department of Treasury
4334 (Rev. 4-08)
Motor Fuel Untaxed Products Return
This form is issued under authority of P.A. 403 of 2000, as amended. Filing is Mandatory.
The purpose of this form is to report gallons and remit the applicable tax for production of untaxed motor fuel products. This form may also be used to
report gallons and remit tax for motor fuel products purchased without the Michigan excise tax but later used in a taxable manner. This form must be
filed by the 20th of the following month after production and/or use.
PART 1: COMPANY INFORMATION
3. Account Number (FEIN,SSN TR or ME
1. Name and Mailing Address
2. Report Period (MM/YYYY)
Number)
4. Contact Person Name
5. Telephone Number
6. Fax Number
7. E-Mail Address
4. Biodiesel
(see
PART 2: TAX COMPUTATION
1. Gasoline
2. Ethanol
3. Diesel
instructions)
8.
Total gallons produced for taxable purposes excluding tax-paid
gallons of gasoline and diesel fuel (see instructions).
9.
Total gallons acquired tax-free and sold or used for taxable purposes.
10.
Taxable Gallons. Add lines 8 and 9.
.19
.19
.15
.15
11.
TAX RATE
12.
CALCULATED TAX DUE - Multiply line 10 by the tax rate.
13a.
13b.
13.
Add columns 1 and 2 from line 12 and enter in 13a. Add columns 3
and 4 and enter in 13b.
14.
TOTAL TAX DUE: Add tax due from all columns - line 12.
15.
Penalty (5% of tax due per month to a maximum of 25%.)
16.
Interest (1% above prime rate set January 1 and July 1 of each year.)
17.
TOTAL REMITTANCE. Add lines 13-15.
PART 3: CERTIFICATION
I certify, under penalty of perjury, that I have examined this return, and to the best of my knowledge and belief, it is
true and complete.
I authorize Treasury to discuss my return and attachments with my preparer.
Do not discuss my return with my preparer.
Authorized Signature
Preparer Signature
Printed Name
Printed Name
Title
Address
Telephone Number
Telephone Number
Make checks payable to "State of Michigan." Print your account number (FEIN, TR, ME or SSN Number ) on the front of
your check.
Mail with Remittance to:
Michigan Department of Treasury
P. O. Box 77401
Detroit, MI 48278
Call (517) 636-4600 if you have any questions.
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