Form 3791 - Blender Monthly Tax Return
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2
3Michigan Department of Treasury
3791 (Rev. 8-08)
Reset Form
900-BLN
Blender Monthly Tax Return
Issued under authority of Public Act 403 of 2000, as amended. Filing is mandatory.
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
Schedule
1. Gasoline
5. Aviation
(E70 - E99)
Diesel
(B05 or higher)
PART 1: TAX COMPUTATION
8. Gross taxable gallons from line 27.
1
9. Tax-paid purchases
Subtract
10.
line 9 from line 8.
11. Collection allowance. Multiply line 10 by 1.5% (.015).
12. Subtract line 11 from line 10.
11A
13. Enter gross gallons diverted TO Michigan.
14. Taxable gallons. Add lines 12 and 13.
0.19
0.19
0.15
0.15
0.03
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 the aviation
$
$
$
total from line 15 to 16c.
$
17. Add tax due from all columns on line 16.
$
18. Penalty
$
19. Interest
$
20. Total Remittance.
Questions, call (517) 636-4600. Make check payable to “State of Michigan-Special Taxes.” Print your account number on the front of your check.
MAIL WITH REMITTANCE TO:
Michigan Department of Treasury
P.O. Box 77401
Detroit, Michigan 48278
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