Biodiesel Produced For Individual Use Report Form - Arkansas Department Of Finance And Administration - 2013

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State of Arkansas
DF&A-Revenue Division
Motor Fuel Tax Section
Department of Finance
P. O. Box 1752
Little Rock, AR 72203-1752
Phone: (501)682-4800
and Administration
Fax: (501)682-5599
BIODIESEL PRODUCED FOR INDIVIDUAL USE
Report Form
CALENDAR YEAR 2013
PLEASE PRINT OR TYPE
Name____________________________________________________FEIN/SSN___________________________
Mailing Address ______________________________________________Phone Number____________________
City____________________________________________State__________________Zip Code_______________
Physical location of production facility_____________________________________________________________
1)
Total Gallons of Biodiesel Produced……………………………………………………__________________
2)
Number of gallons of biodiesel produced for non-highway purposes ………………….__________________
3)
Number of gallons of biodiesel produced for use in highway vehicles………………….._________________
4)
Arkansas Diesel Tax Rate is 22.5 cents a gallon or (.225)
5)
ARKANSAS MOTOR FUEL TAX DUE (Multiply Line 3 by .225)………………..$__________________
PLEASE MAKE CHECK PAYABLE TO THE DEPARTMENT OF FINANCE & ADMINISTRATION
AND MAIL TO : MOTOR FUEL TAX SECTION P.O. BOX 1752 LITTLE ROCK, AR. 72203-1752
This report is due by February 1, 2014.
APPLICANT AGREES, UNDER PENALTY OF PERJURY, THAT THE INFORMATION GIVEN ON THIS FORM IS, TO THE BEST OF
THEIR KNOWLEDGE, TRUE, ACCURATE AND COMPLETE.
________________________________________________________
Applicant’s Signature
Date
*THIS REPORT DOES NOT INCLUDE THE FEDERAL EXCISE TAX

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