Form Dr-309634 Sample - Local Government User Of Diesel Fuel Tax Return - 2015 Page 4
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8DR-309634
R. 01/14
Page 4
A. Municipality
B. County
C. School District
Part I - Gasoline
1. Beginning physical inventory: .....................
2. Receipts: .....................................................
3. Disbursements:
a. Off-highway use * ...................................
b. Sales* ....................................................
c. On-highway use ....................................
4. Gain or loss: ................................................
5. Ending physical inventory: ..........................
6. A. Gallons entitled to credit:
(Line 3c minus gain from Line 4) ...........
.143
.143
.143
B. Credit rate: ............................................
7. Gasoline credit: (Line 6A times Line 6B) .....
8. Total gasoline credit: (Line 7, add Columns A, B, and C. Carry to Page 3, Line 12b)
* does not qualify for credit
Municipality
County
School District
Part II - Diesel
D. Tax Paid
E. Tax Unpaid
F. Tax Paid
G. Tax Unpaid
H. Tax Paid
I. Tax Unpaid
1. Beginning physical inventory: .....................
2. Receipts: .....................................................
3. Disbursements:
a. Off-highway use ....................................
b. Sales* ....................................................
c. On-highway use ....................................
4. Gain or loss: ................................................
5. Ending physical inventory: ..........................
6. A. Taxable gallons (Line 3c only): ..............
.173
.173
.173
B. Tax rate
......................................................
7. Tax due: (Line 6A times Line 6B) ................
8. Credit calculation: (Line 3A times 00000) .
.316
9. Credit calculation: (Line 3C minus
Line 4 gain times 0000) .............................
.143
10. Diesel fuel credit (Line 8 plus Line 9) ........
* does not qualify for credit
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