Form Mfd-04 - State Of Georgia Computation Of Prepaid State Tax On Motor Fuel Sales & Use Page 4

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Form MFD-04 (Rev. 6/13)
Page 3
STATE OF GEORGIA COMPUTATION OF PREPAID
STATE TAX ON MOTOR FUEL SALES & USE
License #: _____________________
Period: ____________ To: ____________
PREPAID STATE
NUMBER OF
TAX AMOUNT
**(LESS VENDOR’S
NET TAX
TAX RATE PER
X
=
-
=
GALLONS
DUE
COMPENSATION )
AMOUNT DUE
GALLON
1.
GASOLINE
X
=
-
=
1.
DIESEL
2.
X
=
-
=
2.
(CLEAR/DYED)
AVIATION
3.
X
=
-
=
3.
GASOLINE
4.
L. P. GAS
X
=
-
=
4.
5.
SPECIAL FUEL*
X
=
-
=
5.
TOTAL AMOUNT OF PREPAID STATE TAX DUE AT 4% (LINES 1-5):
(TRANSFER TOTAL TO PAGE 4 LINE 8 OF TAX RETURN)
MOTOR FUEL SALES TO STATE, COUNTY & MUNCIPAL GOVERNMENTS ONLY
PREPAID STATE
NUMBER OF
TAX AMOUNT
**(LESS VENDOR’S
NET TAX
TAX RATE PER
X
=
-
=
GALLONS
DUE
COMPENSATION )
AMOUNT DUE
GALLON
6.
GASOLINE
X
=
-
=
6.
DIESEL
7.
X
=
-
=
7.
(CLEAR/DYED)
AVIATION
8.
X
=
-
=
8.
GASOLINE
9.
L. P. GAS
X
=
-
=
9.
10.
SPECIAL FUEL*
X
=
-
=
10.
TOTAL AMOUNT OF PREPAID STATE TAX DUE AT 3% (LINES 6-10):
(TRANSFER TOTAL TO PAGE 4 LINE 9 OF TAX RETURN)
INSTRUCTIONS
Effective January 1, 2004 all licensed distributors must include on lines 1-5 the Prepaid State Tax upon their use or any sales to persons (except State, County and
Municipal Governments) who are not licensed as a distributor with the Georgia Department of Revenue (GDOR). Use lines 6-10 to report the Prepaid State Tax on
sales to State, County and Municipal Governments Only.
The Prepaid State Tax is published each May and November on the Georgia DOR website
(etax.dor.ga.gov
) and is based on four percent (4%) of the state-wide average
retail sales price by motor fuel type in Georgia. The Prepaid State Taxes on sales and use by State, County and Municipal Governments is based on three percent (3%)
of the state-wide average retail sales price by motor fuel type.
All taxable diesel fuel gallons sold or used for on-road use (clear & dyed) must be reported on the diesel fuel line in order to calculate the amount of Prepaid State Tax
due.
Include all sales/use of CNG on the Special Fuel Line.
*
** Vendor’s Compensation is based on ½ % (.005) of the total prepaid tax amount paid on the tax return if filed timely.
Prepaid State Tax Calculation:
•
Multiply the Prepaid State Tax Rate for each fuel type by the number of gallons sold or used in the State of Georgia and record the total on the Tax
Amount Due line.
•
Subtract the Vendor’s Compensation ½ % (.005) from the Tax Amount Due Line and enter the Net Tax Amount Due.
•
Add all entries in the Net Tax Amount Due column and record the total Amount of Prepaid State Tax Due on the applicable line.
•
The total amount must be brought forward to page 4 of this tax return and recorded on the Prepaid State Tax Due on the applicable line.
Failure to remit the Prepaid State Tax due on the tax return by the due date will result in a 10% penalty on the total Prepaid
State Tax due, a 1% interest assessment per month or fraction thereof until paid and loss of Vendor’s Compensation.

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