Form Dr-309633 Sample - Mass Transit System Provider Fuel Tax Return

Form Dr-309633 Sample - Mass Transit System Provider Fuel Tax Return - 2015 Page 3

00002

DR-309633

Mass Transit System

Florida Department of Revenue

R. 01/13

5050 W Tennessee St

Provider Fuel Tax Return

Page 3

Tallahassee FL 32399-0165

For Calendar Year:

2015

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FEIN:

920002015999900930270312300000000100002

License Number:

Collection Period Ending:

DOR USE ONLY

POSTMARK OR HAND-DELIVERY DATE

Return Due By

Late After

Complete Reverse Side of Return First

Diesel fuel tax due: (Page 4, Part II, Line 7, Column C) ........................................................ 9. ____________________________

CREDITS

10a.

Diesel fuel tax credit: (Page 4, Part II, Line 8, Column B) ................. 10a. _________________________

10b.

Gasoline tax credit: (Page 4, Part I, Line 7, Column A) .................... 10b. _________________________

11.

Combined credits: (Line 10a plus Line 10b) ......................................................................... 11. ___________________________

12.

Net tax due: (Line 9 minus Line 11) ...................................................................................... 12. ___________________________

13.

Penalty: .................................................................................................................................. 13. ___________________________

14.

Interest: ................................................................................................................................. 14. ___________________________

15.

Total due with return: ............................................................................................................ 15. ___________________________

16.

Amount to be refunded: ....................................................................................................... 16. ___________________________

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Check here if you have electronically transmitted funds

Under penalty of perjury, I declare that I have read this return and the facts stated in it are true.

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_________________

Signature of preparer

Title

Date

______________________________________________________________________________________

_________________

Contact Person (Please Print)

Telephone Number