Form Pet 386 - Dealer'S Compressed Natural Gax Return

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TENNESSEE DEPARTMENT OF REVENUE

DEALER'S COMPRESSED NATURAL GAS TAX RETURN

Account No.

SSN or FEIN

Filing Period

PET

Beginning:

Location Address

386

Ending:

}

If this is an AMENDED RETURN,

Due Date

please check the box at right

Returns must be postmarked by the due

date to avoid the assessment of penalty and

interest. Returns must be filed even if no tax

is due.

Make your check payable to the Tennes-

see Department of Revenue for the amount

shown on Line 7 and mail to:

Tennessee Department of Revenue

Andrew Jackson State Office Bldg.

500 Deaderick Street

Nashville, TN 37242

For assistance, you may call in-state toll

REMINDERS

Read line instructions carefully when completing this return.

free 1-800-342-1003 or (615) 253-0600.

Complete all information.

Sign and date your return in the signature box.

TAX COMPUTATION

Note: A gallon equivalent factor of 5.66 pounds per gallon shall be used when completing this return.

1. Total gallons of product available for sale (Include prior month's ending inventory and all receipts of compressed

natural gas during the reporting month) .......................................................................................................................

_______________________________

2. Total gallons sold to vehicles on which the Tennessee compressed natural gas tax must be collected and remitted

_______________________________

3. Total Tax Due - Multiply Line 2 by

¢ per gallon ...............................................................................................

_______________________________

4. Credits: (Enter outstanding credit amount from previous Department of Revenue notices) .........................................

_______________________________

If filed LATE, compute penalty at 5% of the tax (Line 3 minus Line 4) for each 1 to 30 DAY PERIOD or portion thereof for

{

5. Penalty:

which TAX IS DELINQUENT (Total penalty NOT TO EXCEED 25%.) Minimum penalty is $15 regardless of the amount of

tax due or whether there is any tax due..........................................................................................................................................

6. Interest: If filed late, compute interest at

% per annum on the tax (Line 3 minus Line 4) from the due date of

the payment ................................................................................................................................................................

_______________________________

7. TOTAL AMOUNT DUE (Total of lines 3, 5, and 6; subtract Line 4 if applicable) .........................................................

_______________________________

FOR OFFICE

USE ONLY

Under penalties of perjury, I declare that I have examined this claim, and to the best of my knowledge and belief, it is true, correct,

and complete.

Taxpayer's Signature

Date

Title

Tax Preparer Signature

Date