Form Mfd-04 - State Of Georgia Computation Of Prepaid State Tax On Motor Fuel Sales & Use Page 3

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Form MFD-04 (Rev. 6/13)
Motor Fuel Tax Unit
Georgia Department of Revenue
P.O. Box 105088
Atlanta, GA 30348-5088
License #: _____________________
Motor Fuel Tax Report
Debits
L. P. Gas
Special Fuel
1. Beginning GA Inventory……………………......
2. Gallons Received From
Alabama………………………………………..
Florida………………………………………….
North Carolina………………………………….
South Carolina………………………………….
Tennessee…………………………………........
Other……………………………………………
3. Gallons Received From GA Points (Tax Free)…
4. Gallons Received Tax Paid…………………......
5. Compounds…………………………………........
6. Total Debits……………………………………
Credits
7. Transfers To Other States
Alabama……………………...............................
Florida…………………………………………..
North Carolina………………………………….
South Carolina………………………………….
Tennessee………………………………………
Other……………………………………………
8. Sales To U.S. Government………………………
9. Sales To Other Licensed Distributors……….......
10. Non-Taxable Sales And/Or Use……………….
11. Compounds……………………………………...
12. Sales Or Use Of Tax Paid Fuel………………….
13. Sales Of Aviation Gasoline
Sales Of Aviation @ 1 c (AL License)………...
Sales Of Aviation @ 7.5 c (No AL License)…
14. Taxable Sales/Use……………………………….
15. Taxable Sales/Use (County & Municipal Govts)
16. Closing GA Inventory…………………………...
17. Total Credits……………………………………..
18. Total Debits……………………………………...
19. Variations Over (Short)………………………….

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