Form Mvf-3 - Terminal Operator'S Monthly Gasoline Activity Schedule Page 4
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1
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4Specific Line Instructions
Additional Information
General Instructions
Part 1 - Reconciliation
If you need additional information or assistance, call the
1.
You must file Form MVF-3 and your monthly
Excise Unit at 860-541-3224, Monday through Friday, 8:30
Line 1
List actual physical inventory on the first day of the
Form O-MF, Motor Vehicle Fuels Tax Return, with the
a.m. to 4:30 p.m.
month being reported.
Commissioner of Revenue Services not later than the
25th day of the month following the calendar month
Visit the DRS website at to download and
Line 2
Enter total receipts from Part 2.
being reported. Example: The Motor Vehicle Fuels
print Connecticut tax forms.
Tax Return for January 1 through January 31 must be
Line 3
Add Lines 1 and 2.
filed on or before February 25. A return must be filed
Line 4
Enter total disbursements from Part 3.
even if no tax is due.
2.
Enter in the spaces provided: Name of terminal operator,
Line 5
Subtract Line 4 from Line 3.
address of terminal operator, customer name, month,
Line 6
List the actual physical inventory on the last day of
terminal operator’s telephone number, and customer
the month for which a report is being filed.
Connecticut Tax Registration Number.
3.
Separate reports are required for each customer
Line 7
Report the inventory variation on this line. Please
who stores or through-puts gasoline at your terminal.
note that losses in excess of .005% of total
Additionally, you must file a separate report for your
accountable-gallons must be documented and may
own activity at the terminal.
be subject to tax under Conn. Gen. Stat. §12-457.
Unaccounted for fuel for which a distributor has
4.
Mail to:
not submitted a satisfactory explanation will
State of Connecticut
be construed to have been sold or used by the
Department of Revenue Services
distributor.
Excise Taxes Unit
25 Sigourney St Ste 2
Part 2 - Receipts
Hartford CT 06106-5032
List all receipts of gasoline at the terminal by date including
all book transfers.
Additional receipts must be listed on Page 2 with totals
brought forward to Page 1.
If the product was transported by vessel, list the barge or
ship name.
Part 3 - Disbursements
List all disbursements of gasoline from the terminal.
Additional disbursements must be listed on Page 3 with
totals brought forward to Page 1.
If the product was transported by vessel, list the barge or
ship name.
Page 4 of 4
Form MVF-3 Back (Rev. 10/10)
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