Form B/l: Mft-Fsr - Motor Fuel Floor-Stocks Tax Return

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A
D
R
B&L: MFT-FSR
LABAMA
EPARTMENT OF
EVENUE
3/12
Reset
B
& L
T
D
USINESS
ICENSE
AX
IVISION
M
F
S
OTOR
UELS
ECTION
P.O. Box 327540 • Montgomery, AL 36132-7540 • (334) 242-9608 • Fax (334) 242-1199
Motor Fuel Floor-Stocks Tax Return
NAME
MONTH / YEAR
LICENSE NUMBER
FEIN
ADDRESS
CITY
STATE
ZIP
CONTACT NAME
PHONE NUMBER
E-MAIL ADDRESS
Check Here If New Address
(
)
ALL LICENSED DISTRIBUTORS WHO HAVE MOTOR FUEL IN STORAGE ON WHICH THE ALABAMA EXCISE TAX HAS NOT BEEN PAID AS OF SEPTEMBER 30, 2012
MUST FILE THE MOTOR FUEL FLOOR-STOCKS TAX RETURN.
SUMMARY
A
B
C
D
GASOLINE
UNDYED DIESEL
AVIATION GAS
JET FUEL
1 Gallons in Storage as of Close of Business on September 30,
2012 in which Tax Has Not Been Paid. (Ending inventory from
Monthly Distributor Return.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2 Fuel in Terminal Storage on which Tax has Not Been Paid and
Entity is Licensed as a Supplier as of October 1, 2012. (Will be
shown on Terminal Operator’s Monthly Report as Beginning
Inventory for each Licensed Supplier at the Terminal.). . . . . . . . . . . . . . . . .
3 Total Gallons on which the Excise Tax is Due (Line 1 minus Line 2). . . . . .
$0.16
$0.19
$0.095
$0.035
4 Total Rate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5 Tax Due (Line 3 X Line 4) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6 Late File Penalty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
7 Late Pay Penalty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
8 Interest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
9 Total Due (Add Lines 5, 6, 7, and 8) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
10 Total Amount Due (Enter total amount due of all tax types from Line 9, Columns A, B, C, and D)
Payments Over $750 Must be Paid Electronically. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . PAY THIS AMOUNT
The motor fuel floor-stocks tax return is due on or before November 15, 2012, and the payment is due on or before December 31, 2012.
Under penalties of perjury, I declare that I have examined this report, including all accompanying documents, and to the best of my knowledge and belief, it is true, correct, and complete.
Signature: _____________________________________________________________ Date: __________________________________________
Title: __________________________________________________________________ Telephone Number: (_______)______________________

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