Form Gshr - Annual Shrinkage Allowance Computation
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1
2GShr
Maine Revenue Services
Gasoline Distributor
00
Annual Shrinkage Allowance Computation
*1112200*
Due Date
Registration No.
Period Begin
Period End
1. Entity Information
2.
OUT OF BUSINESS?
Date closed:
3.
OWNERSHIP OR NAME CHANGE?
Date
Explanation
SOLD? Date
4.
Do Not Use Red Ink!
ADDRESS CHANGE? Make corrections above and check here
Schedules A and B on reverse side must be completed.
Total Receipts
,
,
,
,
(Box “A” from Sch. A)
1.
x .005 1a.
Total Transfers
,
,
,
,
(Box “D” from Sch.B)
2.
x .005 2a.
,
,
Shrinkage per Receipts and Transfers
Total Lines 1a + 2a
3.
,
,
Maximum Shrinkage Allowance
Line 1 x .01
4.
,
,
Total Allowable Shrinkage
Enter lesser of Line 3 or Line 4
5.
Actual Net Shrinkage
,
,
(Box “B” minus Box “C” from Sch. A)
Cannot be less than zero
6.
Unaccounted Fuel
Line 6 minus Line 5
7.
,
,
If line 7 is zero or less than zero, enter zero, sign the return and mail to Maine Revenue Service.
,
,
.
Additional Excise Tax Due
Line 7 x $ .300
8.
Please mail to: Maine Revenue Service, P.O. Box 1065, Augusta, ME 04332-1065
Phone #
Date
Signature/Title
Print Name
GShr-1 Revised 07/11
For assistance in completing this form, call (207) 624-9609
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