Form Dr-309635 Sample - Blender Fuel Tax Return - 2015 Page 13
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1400007
❑
DR-309635
R. 01/14
Page 13
Schedule 12 — Ultimate vendor credits worksheet for reporting deliveries and exports of tax paid fuel
to consumers who qualify to purchase fuel tax-exempt
Schedule
Company Name
FEIN
Collection Period Ending
GALLONS
DIESEL
A. Gasoline
B. Undyed
C. Dyed
D. Aviation
1.
Total gallons delivered to other tax exempt
entities (Schedule 10): .........................................
2.
Total gallons delivered to U.S. Government tax
exempt - 500 gallons or more (Schedule 8): .......
3.
Total gallons exported by other than
bulk transfer (Schedule 7A): ................................
4.
Total gallons tax paid aviation fuel converted for
highway use (Schedule 5HW): ............................
5.
Total gallons qualifying for credit:
(Add Lines 1,2,3, and 4) ......................................
.28525
.173
.069
6.
State fuel tax rate: .............................................
7.
State tax due: (Line 5 times Line 6) .....................
8.
Collection allowance rates for state tax: ...........
.00314
.0067
.002
9.
State tax collection allowance calculation:
(Line 7 times Line 8) ............................................
10. Local option rate entitled to
.07
collection allowance: ...........................................
11. Portion of local option tax entitled to collection
allowance: (Line 5, Column B times Line 10) ......
12. Local option collection allowance rate: ...............
.011
13. Local option collection allowance
calculation: (Line 11 times Line 12) .....................
14. Local option tax rate not entitled to
collection allowance: ...........................................
.073
15. Portion of local option tax not entitled to collection
allowance: (Line 5, Column B times Line 14) ........
16. Ultimate vendor credit calculation:
a. Gasoline: (Line 7 minus Line 9) .......................
b. Diesel: (Line 7 minus Line 9 plus Line 11
minus Line 13 plus Line 15) .................................
c. Aviation: (Line 7 minus Line 9) .........................
Shared Collection Allowance Add-back
17. Enter the amount from Line 5 above (total gallons
qualifying for credit): If zero, skip to Line 24 .......
18. Enter the amount from Line 7, Page 4 of this
return (net taxable gallons): .................................
19. Gallons subject to shared collection allowance
calculation: (Line 17 minus Line 18). If negative,
enter zero and skip to Line 24 .............................
20. State fuel tax rate: ..............................................
.28525
.173
.069
21. Tax subject to shared collection allowance:
(Line 19 times Line 20) ........................................
22. Shared collection allowance add-back rates: .....
.00157
.001
.00335
23. Shared collection allowance add-back:
(Line 21 times Line 22) ........................................
24. Allowable ultimate vendor credit
A. Gasoline: (Line 16A plus Line 23A ) ................
B. Diesel: (Line 16B plus Line 23B) .....................
C. Aviation: (Line 16C plus Line 23C) ..................
25. Total ultimate vendor credit amount: (Add Line 24A, Line 24B, and Line 24C. Carry forward to Page 3, Line 25.) . ......
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