International Fuel Tax Agreement Tax Return
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4SOUTH DAKOTA
Reporting Period: 201104
Ending Period: 12/31/2011
Return Due Date: 1/31/2012
License Number:
Fuel Type: D
A.
Total Miles Traveled in all
INTERNATIONAL FUEL TAX AGREEMENT TAX RETURN
States
B.
Total Fuel Consumed in all
States
C.
*Average Miles/Gallon (Line
A Divided by Line B)
Name:
South Dakota Department of Revenue
Mail To:
Remittance Center
Address:
PO BOX 5055
City, State, Zip:
Sioux Falls, SD 57117-5055
A RETURN MUST BE FILED EVEN IF NO MILES TRAVELED
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3
4
5
6
7
8
9
10
Total Taxable
Tax Paid
Interest Due
Taxable Gallons
Net Gallons
Tax Due/Credit
Tot Due/Credit
Jurisdiction
Total Miles
Tax Rate
Miles
Gallons
.0100
(Col 3/Line C)
(Col 4- Col 5)
(Col 6 x Col 7)
(Col 8 + Col 9)
SD
0.2200
AB
0.3442
0.1900
AL
0.2250
AR
AZ
0.2600
BC
0.8180
CA
0.3470
CO
0.2050
0.4620
CT
0.2200
DE
FL
0.3207
GA
0. 1830
IA
0.2250
0.2500
ID
0.3780
IL
IN
0.1600
I2
0.1100
KS
0.2600
KY
0.2340
0.1120
K2
0.2000
LA
MA
0.2100
MB
0.4398
Page 1
Total IFTA Miles Page 1
TOTAL OF COLUMN 10 Page 1
Page 2
Total IFTA Miles Page 2
TOTAL OF COLUMN 10 Page 2
SUBTOTAL
Total IFTA Miles
GRAND TOTAL COLUMN 10
PENALTY - 10%of Tax Due or
ADD
Total Mileage of all NON-IFTA States and Provinces
$50.00, whichever is greater
GRAND
(+ or -) Balance Due/Credit from
Total All Miles Traveled (Same as (A) above)
TOTAL
Prior Return
TOTAL DUE
* When calculating your average miles per gallon, extend two decimals only (ex. 2.86)
**When recording gallons, round up to the nearest whole gallon (ex. 52.8 = 53)
TOTAL REMITTED
I CERTIFY THAT THIS REPORT IS TRUE, CORRECT AND COMPLETE TO THE BEST OF MY KNOWLEDGE
TO CANCEL IFTA LICENSE, ATTACH IFTA PERMIT AND GIVE LAST DATE OF
OPERATION __________________
SIGNATURE – LICENSEE
DATE
NOTE: Please see information on Page 2
PHONE NO.
TITLE
Note: Please photocopy this return for your records. Please use black ink.
Page 1
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