Michigan Department of Treasury
440-IMP
Issued under authority of P.A. 403 of 2000, as amended. Filing is Mandatory.
3992 (Rev. 4-09)
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Fuel Importer Return
This report is due
2. Account Number (FEIN or TR)
2A. License Number
3. Report Period (MM/YYYY)
1. Company Name and Mailing Address
4. Contact Person Name
5. Telephone Number
6. Fax Number
7. E-Mail Address
2. Ethanol Blends
3. Undyed Petroleum
4. Undyed Biodiesel
PART 1: TAX COMPUTATION
Schedule
1. Gasoline
5. Aviation
(E70 - E99)
Diesel
(B05 or higher)
8. Taxable gallons from line 27.
1
9. Tax-paid purchases.
10. Subtract lines 9 from line 8.
11. Collection Allowance. Multiply line 10 by 1.5% (.015).
12. Subtract line 11 from line 10.
11A
13. Diversions TO Michigan.
14. Add lines 12-13.
.19
.19
.15
.15
.03
TAX RATE
$
$
$
$
$
15. Tax due. Multiply line 14 by tax rate.
16a.
16b.
16c.
16. Add Columns 1 and 2 from line 15 and enter in 16a.
$
$
$
Add columns 3 and 4 and enter in 16b. Carry aviation total
from line 15 to 16c.
$
17. Add tax due from all columns of line 16.
$
18. Penalty.
$
19. Interest.
$
20. Total remittance. Add lines 17-19.
CERTIFICATIONS
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. Importers of Gasoline/Ethanol Blends/Aviation Fuel: I certify to
the best of my knowledge and belief that any and all suppliers, wholesalers or retailers of gasoline or aviation fuel to whom gasoline or aviation fuel, as defined by statute, was sold by this importer
during the period covered by this report, have been paid or credited as follows:
(A) To Suppliers/Wholesalers - 1.5% of the tax charged as allowed by statute to licensed suppliers of gasoline or aviation fuel.
(B) To Retailers - 1/3 of the 1.5% allowed by statute to licensed suppliers of gasoline or aviation fuel.
(C) No credits or payments have been extended during this report period as no sales of gasoline or aviation fuel have been made to any supplier/wholesaler or retailer.
I authorize Treasury to discuss my return and attachments with my preparer.
Do not discuss with my preparer.
Authorized Signature
Printed Name
Telephone Number
Title
Date