Form Mfa-10 - Floorstock Tax Return
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5Division use only — DLN Stamp
Division use only — Date Stamp
Send Report and Payment to:
Revenue Processing Center
PO Box 243
Pursuant to NJSA 54:39-150
Trenton, NJ 08695-0243
10-2010
FloorStock Tax Return
MFA-10
Taxpayer
Tax ID #
License(s) Held Before Jan 1, 2011
Distributor
Wholesaler
Address
Jobber
Retailer
Importer
Seller / User
City, State Zip
Check all that apply
Report due on or before January 31, 2011
Payment due on or before July 1, 2011
Gallons in inventory
Line
Product
as of close of business
Tax Rate
Tax Due
on December 31, 2010
Gasoline
$
X .105
1
from Schedule MFA-101
Diesel Type Fuels
$
X .135
2
from Schedule MFA-201
LPG
$
X .0525
3
from Schedule MFA-301
Aviation Fuels
$
X .020
4
from Schedule MFA-401
Total Tax Due
$
5
add total of lines 1 through 4
Discount
$
6
if payment in full is made by January 31, 2011, 10% of tax due; otherwise 0
Total Tax Liability
$
7
Subtract line 6 from line 5
Date
Signature of Taxpayer *
Title
Date
Signature of Individual Completing This Return*
Firm
*Signature of taxpayer is a declaration, under penalty of law, that the above information was examined by the signatory and is accurate.
Signature by a Individual Completing This Return indicates that the above information was provided by the taxpayer, and is, to the best of his/her
knowledge, accurate.
This form is in compliance with NJSA §54:39-101 et seq
Mail this report with check for tax due payable to
"State of New Jersey - LMF" to:
Failure to file and remit payment correctly will
Revenue Processing Center
result in the assessment of penalties and
interest, as per NJSA §54:39-101 et seq
PO Box 243, Trenton, NJ 08646-0243
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