Form 173 - Report Of Fuel Sales Tax Prepayment And Environmental Protection Regulatory Fee For Refinders, Terminal Operators And Importers
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1
2
3Michigan Department of Treasury
Mail to:
173 (Rev. 04-13)
Michigan Department of Treasury
Report of Fuel Sales Tax Prepayment and Environmental Protection
Department 771410
P.O. Box 77000
Regulatory Fee for Refiners, Terminal Operators and Importers
Detroit, MI 48277-1410
Issued under authority of Public Act 167 of 1933. Filing is mandatory
If this is your first return, enter date
Business Name
Account Number
Date Payment Invoiced
To
Address
Telephone Number
Report Due Date
SALES TAX PREPAYMENT
Complete page 2 of this form.
A. Diesel Fuel
B. Gasoline
C. Regulatory Fee
1. Total gallons ................................................................
.00875
2. Current rates (per gallon) ...........................................
=
+
+
3. Multiply gallons by rate. Enter amount due or (credit)
3.
+
4. Penalty and interest ...............................................................................................................................................................................
4.
(
)
5. Regulatory fee credit carried forward from previous return ...................................................................................................................
5.
6. Enter total of lines 3, 4 and 5. Pay amount due, or indicate total is
Credit Forward
Refund ............................................
6.
Signature
Title
Date
Michigan Department of Treasury
Mail to:
173 (Rev. 04-13)
Michigan Department of Treasury
Report of Fuel Sales Tax Prepayment and Environmental Protection
Department 771410
P.O. Box 77000
Regulatory Fee for Refiners, Terminal Operators and Importers
Detroit, MI 48277-1410
Issued under authority of Public Act 167 of 1933. Filing is mandatory
If this is your first return, enter date
Business Name
Account Number
Date Payment Invoiced
To
Address
Telephone Number
Report Due Date
SALES TAX PREPAYMENT
Complete page 2 of this form.
A. Diesel Fuel
B. Gasoline
C. Regulatory Fee
1. Total gallons ................................................................
.00875
2. Current rates (per gallon) ...........................................
=
+
+
3. Multiply gallons by rate. Enter amount due or (credit)
3.
+
4. Penalty and interest ...............................................................................................................................................................................
4.
(
)
5. Regulatory fee credit carried forward from previous return ...................................................................................................................
5.
6. Enter total of lines 3, 4 and 5. Pay amount due, or indicate total is
Credit Forward
Refund ............................................
6.
Signature
Title
Date
Michigan Department of Treasury
Mail to:
173 (Rev. 04-13)
Michigan Department of Treasury
Report of Fuel Sales Tax Prepayment and Environmental Protection
Department 771410
P.O. Box 77000
Regulatory Fee for Refiners, Terminal Operators and Importers
Detroit, MI 48277-1410
Issued under authority of Public Act 167 of 1933. Filing is mandatory
If this is your first return, enter date
Business Name
Account Number
Date Payment Invoiced
To
Address
Telephone Number
Report Due Date
SALES TAX PREPAYMENT
Complete page 2 of this form.
A. Diesel Fuel
B. Gasoline
C. Regulatory Fee
1. Total gallons ................................................................
.00875
2. Current rates (per gallon) ...........................................
=
+
+
3. Multiply gallons by rate. Enter amount due or (credit)
3.
+
4. Penalty and interest ...............................................................................................................................................................................
4.
(
)
5. Regulatory fee credit carried forward from previous return ...................................................................................................................
5.
6. Enter total of lines 3, 4 and 5. Pay amount due, or indicate total is
Credit Forward
Refund ............................................
6.
Signature
Title
Date
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