Form Dmf-101 - Alternative Fuels Tax Report - 2013
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2PAGE 1
DMF-101 (01-13)
FOR OFFICIAL USE ONLY
1
2013 ALTERNATIVE FUELS
TAX REPORT
2
BUREAU OF MOTOR &
ALTERNATIVE FUEL TAXES
PO BOX 280646
3
HARRISBURG PA 17128-0646
TELEPHONE 1-800-482-4382
4
START
HERE
Corporation Name
TAX ID NUMBER (FEIN):
First Line of Corporation's Address
Beginning and Ending mm/dd/yyyy
TAX PERIOD:
Second Line of Corporation's Address
City
State
ZIP Code
Due by the 20th day of the following month.
Use this form to calculate and pay liquid fuels and fuels tax on alternative fuels placed into fuel supply tanks of alternative
fuel vehicles in Pennsylvania for use on public highways.
SEE REVERSE FOR INSTRUCTIONS
ALTERNATIVE
VOLUME
TAX RATE
TAX DUE
FUEL
=
x
HYDROGEN
GGE
0.312
x
=
CNG
GGE
0.312
=
x
LNG
gals
0.204
x
=
PROPANE/LPG
gals
0.228
=
x
E-85
gals
0.219
x
=
ETHANOL
gals
0.208
=
x
M-85
gals
0.178
=
x
METHANOL
gals
0.154
=
x
ELECTRICITY
kWh
0.0093
x
OTHER
=
Amount Due:
Less Discount:
Make check payable to PA Dept. of Revenue.
Total Due:
I certify the information provided on this form has been examined by me and is, to the best of my knowledge, true and correct.
mm/dd/yyyy
Print Name
Title
Date
Signature
Telephone Number
Please remember to sign your DMF-100 after printing.
Mail this alternative fuels tax report and remittance to the address at the bottom of this form. To avoid penalty
and interest, file by the due date.
THIS FORM MAY BE REPRODUCED AS NEEDED
RETURN TO TOP
PRINT FORM
Reset Entire Form
Bureau of Motor and Alternative Fuel Taxes
PO Box 280646 l Hbg, PA 17128-0646 l 800.482.4382 l
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