Form Sft-3 Schedule Lg - Liquified Gases Only

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Schedule LG

Massachusetts

Liquified Gases Only

Department of

(propane, etc.)

Revenue

Month

Year

Name of licensee

Federal Identification number

Street address

License number

City

State

Zip

Address where records are kept (if different from above)

Telephone number

“Liquified gas” is that type of special fuel which is a combustible gas and exists in a gaseous state at a temperature of 60° Fahrenheit and a pressure of

14.7 pounds per square inch absolute.

Inventories and Receipts

G G a a l l l l o o n n s s (use whole gallons)

11 Inventory on hand, first of month (Attach explanation if different from

prior month closing inventory) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

12 Gallons purchased (Schedule F). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

13 Total gallons. Add lines 1 and 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

14 Actual inventory on hand, end of month . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

15 Total gallons to be accounted for. Subtract line 3 from line 4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Disposition

16 Taxable gallons placed or used in own or leased registered motor vehicles (Schedule G). . . . . . . 6

17 Taxable gallons sold to other users (Schedule H) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

18 Taxable gallons sold to user-sellers (Schedule I) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

19 Total taxable gallons. Add lines 6 through 8. Enter here and on Form SFT3, page 1, line 3 . . . . . . . . . . . . . . . . . . . . . . . . . . 9

10 Non-taxable gallons sold or used in non-registered equipment (Schedule J) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

11 Total gallons. Add lines 9 and 10. Must equal line 5. If not, explain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Taxable Gallons By Type of Liquified Gas and Costs/Receipts Attributable to Such Type of Special

Fuel for Massachusetts Tax Purposes

Schedule G

Type of liquified gas

a. Gross costs

b. Gallons

Propane (convert at: 4.23 lb = 1 gal.)

Other __________________________________

Totals

Gross costs: for purposes of col. a above, means the total amount, exclusive of U.S. and Massachusetts fuel taxes, paid by you as consideration of fuel

used by you and not resold, for purchases valued in money or otherwise, including any amounts for which credit was given to you and any fuel transporta-

tion cost to you.

Records to substantiate the above costs/receipts and gallonage computations must be retained for audit.

Declaration

Under the penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best

of my knowledge and belief, it is true, correct and complete. Declaration of preparer (other than taxpayer) is based on all information of which

he/she has knowledge.

Signature

Title

Date

Use additional sheets if necessary, and attach to this return.

Schedule LG Form SFT-3