Form Dmf-77 - Alternative Fuels Tax Report
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2DMF-77 (12-02)
Bureau of Motor Fuel Taxes
Dept. 280646
Harrisburg, PA 17128-0646
ALTERNATIVE FUELS TAX REPORT
USE FOR YEARS: 1997, 1998, 1999, 2000 AND 2003
TAX I.D. NO. (FEIN):
TAX PERIOD:
DUE DATE:
Use this form to calculate and pay Liquid Fuels and Fuels Tax on “Alternative Fuels” placed into the fuel supply tank of an
alternative fuel vehicle, in Pennsylvania, for use on a public highway.
SEE REVERSE SIDE FOR INSTRUCTIONS
TAX
ALTERNATIVE
VOLUME
TAX RATE
DUE
FUEL *
=
x
CNG (gal)
Gals
.066 gal
x
=
Propane/LPG (gal)
Gals
.189 gal
=
x
ETHANOL (gal)
Gals
.173 gal
x
=
METHANOL (gal)
Gals
.128 gal
=
x
E-85 (gal)
Gals
.239 gal
x
=
M-85 (gal)
Gals
.148 gal
=
x
LNG (gal)
Gals
.151 gal
=
x
(Kwh)
ELECTRICITY
kWh
.008 kWh
=
x
Other (specify)
*
FOR PREPAYMENT OF TAX INSTRUCTIONS – SEE REVERSE SIDE
Amount Due
Less Discount
Make check payable to the “PA Dept. of Revenue”
Total Due
I certify that the information provided on this form has been examined by me and is, to the best of my knowledge, true and correct.
Print Name
Title
Date
Signature
Telephone Number
Mail this Alternative Fuels Tax Report along with your remittance to the address shown at the top of this form. To avoid
penalty and interest file by the due date shown.
THIS FORM MAY BE REPRODUCED AS NEEDED
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