Division use only - DLN Stamp
Division use only Date Stamp
This report is for Calendar Year
Period
Send to:
Revenue Processing Center
and is due the following February 22.
PO Box 243
Pursuant to NJSA 54:39-101 et seq
Trenton, NJ 08646-0243
10-2010
TERMINAL OPERATOR LOSS RETURN
OMF-10
Terminal Operator Name
NJ ID #
Terminal Name
Terminal #
Address
Location
City, State Zip
City, State Zip
Gasoline
Diesel/ Kerosene
LPG
Beginning Inventory
1
Fuel Received During the Year
2
Total
3
Line 1 plus Line 2
Fuel Removed During the Year
4
Ending Inventory
5
Total
6
Line 4 plus Line 5
Total Loss
7
Line 3 minus Line 6
Acceptable Loss
8
Line 4 times .005
Taxable Loss
9
Line 7 minus Line 8
Tax Rates
0.105
0.135
0.0525
10
Taxes Due
11
Line 9 times Line 10
Total Tax Due
Send check payable to:
$
12
State of New Jersey- LMF-TO
Add all 3 columns of Line 11
By signing, I declare under the penalties provided by the law that this return (including any accompanying schedules and statements) has been examined by me and to the best of my knowledge
and belief is a true, correct, and complete return. If the return is prepared by a person other than the Taxpayer, this declaration is based on all the information relating to the matters required to be
reported in the return of which he has knowledge.
Signature of individual Filing this Report
Printed Name
Company
Date
Signature of Taxpayer or Authorized Officer
Printed Name
Title
Date