Form Dr 0122 - International Fuel Tax Agreement Tax Report printable pdf download

Form Dr 0122 - International Fuel Tax Agreement Tax Report

Departmental Use Only

DR 0122 (06/28/13)

COLORADO DEPARTMENT OF REVENUE

Denver CO 80261-0009

International Fuel Tax Agreement

Tax Report

Show below change of ownership, name and/or address

Photocopy and Keep for your Own Records

Colorado Account Number

IFTA Account No. (FEIN or

Period

Due Date

5600-100

SSN)

•

1. Miles/gallon during this quarter

A. Total miles traveled in all jurisdictions _______

•

B. Total gallons (both IFTA and non-IFTA jurisdictions) _______

(Line A divided by Line B equals Line

C; use two decimal places: 0.00)

C. Average miles per gallon

_______

•

2. Fuel Type

1. Diesel

2. LPG

3. Gasoline

4. Gasohol

5. LNG (Natural Gas)

6. CNG

7. Ethanol

8. Methanol

9. E-85

10. M-85

11. A55

IFTA Tax Computations (round to the nearest whole gallon and mile) — Continued on the Reverse Side

5. Total

6. Taxable

8. Net Taxable

9. Tax Rate

12. Total

•

7. Tax Paid

10. Tax (8 x 9)

11. Interest Due

•

3. Jurisdiction

•

4. Total Miles

Taxable Miles

Gallons

Gallons (6-7)

(per gallon)

(10 + 11)

Gallons

Form Dr 0122 - International Fuel Tax Agreement Tax Report

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