Form Pet 365 - Liquified Gas User Addendum Page 2
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1
2SUPPLEMENTAL SCHEDULE
ADDENDUM FOR LIQUIFIED GAS VEHICLE DECALS
COMPUTATION OF FEES
PART I - ANNUAL FEES
Annual fees are based on an accounting period beginning July 1, and ending June 30, of each fiscal year. List below all vehicles which need registration
decals for the full twelve month period. If you are using this form as an addendum for vehicles acquired on or after August 1 of the current fiscal year, use
Part II below. See Schedule of Fees below to determine the proper class for each vehicle and the correct fee due. If additional space is required to list
vehicles, attach a supplemental schedule to this form.
VEHICLE
REGISTERED
MODEL
ODOMETER
GROSS
YEAR
MAKE
VIN
LICENSE
READING
WEIGHT
CLASS
FEE
1. ______
___________
_______________________________
______________
_____________
_____________
_______ ______________
2. ______
___________
_______________________________
______________
_____________
_____________
_______ ______________
3. ______
___________
_______________________________
______________
_____________
_____________
_______ ______________
4. ______
___________
_______________________________
______________
_____________
_____________
_______ ______________
5. ______
___________
_______________________________
______________
_____________
_____________
_______ ______________
6. ______
___________
_______________________________
______________
_____________
_____________
_______ ______________
7. ______
___________
_______________________________
______________
_____________
_____________
_______ ______________
8. ______
___________
_______________________________
______________
_____________
_____________
_______ ______________
9. ______
___________
_______________________________
______________
_____________
_____________
_______ ______________
10. ______
___________
_______________________________
______________
_____________
_____________
_______ ______________
Schedule Total $ ________________
(Transfer Schedule Total to Line 1on front of addendum)
PART II - PRORATED FEES
This section is to be completed by persons who have acquired L.G. vehicles or converted vehicles to L.G. during the annual period. Using the Schedule of
Fees below, compute the amount due for each vehicle by multiplying the number of months remaining in the tax year (July 1 through June 30) by the monthly
rate for each class of vehicle.
VEHICLE
REGISTERED
DATE ACQUIRED
MODEL
ODOMETER
GROSS
OR
YEAR
MAKE
VIN
LICENSE
READING
WEIGHT
CONVERTED
CLASS
FEE
1. ______
_________ ____________________________
____________
____________
____________
_____________
_______
________
2. ______
_________ ____________________________
____________
____________
____________
_____________
_______
________
3. ______
_________ ____________________________
____________
____________
____________
_____________
_______
________
4. ______
_________ ____________________________
____________
____________
____________
_____________
_______
________
5. ______
_________ ____________________________
____________
____________
____________
_____________
_______
________
6. ______
_________ ____________________________
____________
____________
____________
_____________
_______
________
7. ______
_________ ____________________________
____________
____________
____________
_____________
_______
________
8. ______
_________ ____________________________
____________
____________
____________
_____________
_______
________
9. ______
_________ ____________________________
____________
____________
____________
_____________
_______
________
10. ______
_________ ____________________________
____________
____________
____________
_____________
_______
________
Schedule Total $ ________________
(Transfer Schedule Total to Line 2 on front of addendum)
Schedule Of Fees
MAX GROSS WEIGHT
PRORATED
CLASS OF VEHICLE
INCLUDING VEH. & LOAD
ANNUAL FEE
MONTHLY FEE
PASSENGER CAR
- - -
$ 70
$ 6.00
CLASS 1
(includes Pick-ups) 9,000#
84
7.00
CLASS 2
16,000#
84
7.00
CLASS 3
20,000#
100
8.50
CLASS 4
26,000#
100
8.50
CLASS 5
Greater than 26,000#
114
9.50
INTERNET (2-04)
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