Form Dr-309632 Sample - Wholesaler/importer Fuel Tax Return - 2015 Page 4
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14DR-309632
R. 01/14
Page 4
Company Name
FEIN
Collection Period Ending
GALLONS
DIESEL
A. Gasoline
B. Undyed
C. Dyed
D. Aviation
1.
Beginning physical inventory: ............................
2.
Receipts: (Page 5, Section I, Line 6) ..................
3.
Disbursements: (Page 5, Section II, Line 9) .........
4.
Transfers: ............................................................
5.
Gain or (Loss): ....................................................
6.
Ending physical inventory: .................................
7.
Net taxable gallons: (Page 5, Section I, Line 5) .....
State Tax Calculations
DOLLARS
8.
Gasoline (Line 7, Column A times
0),
.28525
and Diesel: (Line 7, Column B times 0000) .......
.173
9.
Aviation: (Line 7, Column D times 0000) ............
.069
10. Collection allowance -
Gasoline: (Line 8, Column A times
000)
.00314
Aviation: (Line 9, Column D times 0000) ............
.002
11. Collection allowance -
Diesel: (Line 8, Column B times 0000000) .........
.0067
12. Net state fuel tax due: ........................................
DIESEL
Local Option - Tax and Collection Allowance
A. Gasoline
B. Undyed
C. Dyed
D. Aviation
Calculations - Gasoline
13. Local option tax entitled to collection
allowance - Gasoline:
(Schedule 11, Page 12, Column C total) ............
14. Collection allowance - gasoline local
option tax: (Line 13, Column A times 0000) .......
.011
15. Local option tax not entitled to
collection allowance - Gasoline: (Schedule 11,
Page 12, Column E total) ...................................
16. Total local option tax due - Gasoline:
(Line 13 minus Line 14 plus Line 15) ..................
Local Option - Tax and Collection Allowance
Calculation - Diesel
17. Local option tax entitled to collection
allowance - Diesel:
(Line 7, Column B times 0000) ...........................
.07
18. Collection allowance - diesel local
option tax: (Line 17 times 0000) .........................
.011
19. Local option tax not entitled to collection
allowance - Diesel:
(Line 7, Column B times 0000) ...........................
.073
20. Total local option tax due - Diesel:
(Line 17 minus Line 18 plus Line 19) ..................
Total State and Local Option
Tax Due Calculations
21. Total tax due - Gasoline: (Line 12, Column A
plus Line 16, Column A) .....................................
22. Total tax due - Diesel: (Line 12, Column B plus
Line 20, Column B) .............................................
23. Total tax due - Aviation:
(Line 12, Column D) ............................................
24. Combined gasoline, diesel, and aviation fuel tax due: (Add Lines 21, 22, and 23. Carry to Page 3, Line 24.) ......
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