TENNESSEE DEPARTMENT OF REVENUE
MOTOR OIL FEE RETURN
For
SSN
FEIN
Due
Period
Date
Ending
ACCOUNT NO.
This return must be filed and the proper tax
paid on or before the 25th day of the month
following the quarterly period. THE RETURN
MUST BE FILED TIMELY EVEN IF NO TAX IS
DUE.
Make your check payable to the Tennessee
Department of Revenue for the amount
shown on Line 6 and mail to:
Tennessee Department of Revenue
Andrew Jackson State Office Building
500 Deaderick Street
Nashville, TN 37242
REMINDERS
1) Read instructions on reverse side before preparing this worksheet.
2) Transfer the amounts reported in the worksheet to the corresponding item numbers in the bottom portion.
3) Be sure to sign and date your return in the signature box on the back of the form.
WORKSHEET FOR COMPUTING TAX
ROUND TO NEAREST DOLLAR
00
1. OIL FEE (Total from Schedule A. Line E ________________ multiplied by 2¢) ..............................................................
___________________________
00
2. VENDOR'S COMPENSATION (Deduct 2.00% of the first $2,500.00 of the total tax on Line 1 for timely filing) ..............
___________________________
00
3. ENTER CREDIT AMOUNT (if applicable) .....................................................................................................................
___________________________
00
4. PENALTY (If filed late, see instructions on reverse side) ..........................................................................................
___________________________
00
5. INTEREST (If filed late, see instructions on reverse side; current interest rate per annum is
% ) .................
___________________________
6. TOTAL AMOUNT REMITTED (If filed late, add Lines 1, 4, and 5 and subtract Line 3 if applicable. If filed timely,
00
subtract Line 2 from Line 1 and subtract Line 3 if applicable) ....................................................................................
___________________________
WRITE NUMBERS LIKE THIS
Keep Upper Portion For Your Records
Return Copy Below - Detach Here
TENNESSEE DEPARTMENT OF REVENUE
OIL
MOTOR OIL FEE RETURN
00
Due
For Period
1. OIL FEE
409
Date
Ending
00
ACCOUNT NO.
2. VENDOR'S COMPENSATION
00
3. CREDIT AMOUNT
00
4. PENALTY
If an amended
return, check
00
5. INTEREST
box above
(
per annum)
00
6. TOTAL REMITTED
RV-R0000301
INTERNET (9-08)