Form Pet 356 - Liquified Gas User Annual Tax Return Page 2

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For additional information, contact the Taxpayer Services Division in one of our Department of Revenue Offices:

Jackson

Johnson City

Knoxville

Memphis

Nashville

Chattanooga

(901) 213-1400

(615) 253-0600

(423) 634-6266

(731) 423-5747

(423) 854-5321

(865) 594-6100

Suite 340

204 High Point Drive

Room 606

3150 Appling Road

3rd Floor

Suite 350

Bartlett, TN

Andrew Jackson Building

State Office Building

Lowell Thomas Building

State Office Building

225 Martin Luther King Blvd.

531 Henley Street

500 Deaderick Street

540 McCallie Avenue

Tennessee residents can also call our statewide toll free number at 1-800-342-1003.

Out-of-state callers must dial (615) 253-0600.

Instructions

This is an annual return for vehicles that operate on Liquified Gas. The amount on Line 5 on the front of the return reflects the total amount of decals purchased during

the filing period. The total gallons consumed in Tennessee is calculated on Schedule A and any potential credit that may be due for out-of-state miles or discontinued

vehicles is calculated on Schedule B. Complete Schedule A before completing the front of the return.

SCHEDULE A

Divide the miles on each class by the MPG allowed to determine the number of gallons (attach Vehicle Schedule C).

Miles

Gallons

TN Miles - Passenger Cars

____________________

19 MPG=

________________

TN Miles - Class 1 Vehicles

____________________

14 MPG=

________________

TN Miles - Class 2 Vehicles

____________________

14 MPG=

________________

TN Miles - Class 3 Vehicles

____________________

8 MPG=

________________

TN Miles - Class 4 Vehicles

____________________

8 MPG=

________________

TN Miles - Class 5 Vehicles

____________________

5 MPG=

________________

Add lines 1, 2, 3, 4, 5, and 6 and enter here and on Line 1 on front of return ............................................. (7) ________________

SCHEDULE B

Complete only if Line 5 on the front is greater than Line 2 and if you discontinued use of vehicle or had out-of-state mileage during the reporting

period. A discontinued vehicle is a vehicle that has been sold, destroyed, or had the carburetor system removed. Multiply the monthly prorated

fee (use Schedule of Monthly Prorated Fees below) by the number of months out of service. If additional space is required, attach separate sheets.

Maximum Potential Credit

1. Subtract Line 2 from Line 5 on the front of the return and enter ............................................................................. (1) $ ______________

Discontinued Vehicle

Date

Vehicle

Monthly

Whole Months

Vehicle

Schedule of Monthly

Vehicle ID

Discontinued

Class

Prorated Fee Out of Service

Credit

Prorated Fees

Passenger Cars

$6.00

2. ____________________ ___________

______

__________ X _________ = $ _____________

Class 1(Includes Pick-ups) $7.00

3. ____________________ ___________

______

__________ X _________ = $ _____________

Class 2

$7.00

Class 3

$8.50

4. ____________________ ___________

______

__________ X _________ = $ _____________

Class 4

$8.50

5. Total discontinued vehicle credit. Add lines 2, 3, and 4 ........................................ (5) $ ______________

Class 5

$9.50

Out-Of-State Mileage Credit

Divide the miles on each class by the MPG allowed to determine the number of gallons (attach Vehicle Schedule C).

6. Passenger Cars

____________________ ÷ 19 MPG = _________________

7. Class 1 Vehicles

____________________ ÷ 14 MPG = _________________

8. Class 2 Vehicles

____________________ ÷ 14 MPG = _________________

9. Class 3 Vehicles

____________________ ÷ 8 MPG = _________________

10. Class 4 Vehicles

____________________ ÷ 8 MPG = _________________

11. Class 5 Vehicles

____________________ ÷ 5 MPG = _________________

12. Total Gallons Used Out-Of-State - add lines 6 through 11

_________________

13. Total Mileage Credit - multiply gallons on Line 12 by

¢ ...................................... (13) $ _________________

14. Total Credit - add lines 5 & 13 ............................................................................................................................. (14) $ _______________

15. Enter the lesser of the credits on Line 1 or Line 14 and carry forward to Line 6 on the front of the return ...... (15) $ _______________