Form Pet 373 - Petroleum Products Transporter Return

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TENNESSEE DEPARTMENT OF REVENUE

PETROLEUM PRODUCTS TRANSPORTER RETURN

SSN or FEIN

Account Number

Filing

Period

PET

Location Address

373

Due

Date

License Number

Complete all lines and schedules. If pen-

alty is applicable, make your check out to

the Tennessee Department of Revenue and

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

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

REMINDERS

1. Read line instructions carefully when completing this return.

}

If this is an AMENDED RETURN,

2. Complete all information and schedules.

please check the box at right

3. Transfer totals from schedules to appropriate lines.

4. Sign and date your return in the signature box.

1. Total net gallons product loaded at a Tennessee terminal, bulk plant, or refinery and delivered

to another state (attach Schedule 1A) .............................................................................................

_____________________

2. Total net gallons product loaded at an out-of-state terminal, bulk plant, or refinery and delivered

to Tennessee (attach Schedule 2A) ................................................................................................

_____________________

3. Total net gallons product loaded at a Tennessee refinery and delivered in Tennessee (attach

Schedule 3A) ..................................................................................................................................

_____________________

4. Total gallons of petroleum product transported (total of lines 1 through 3) ........................................

_____________________

5. Penalty - If filed late, penalty of $15 is due ......................................................................................

_____________________

6. Total remittance - Line 5 penalty if return is filed late .......................................................................

_____________________

FOR OFFICE

USE ONLY

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

_______________________________________________________________________

________________

____________________________________

Taxpayer's Signature

Date

Title

_______________________________________________________________________

________________

____________________________________

Tax Preparer's Signature

Date

Telephone