Form Dr-309635 Draft - Blender Fuel Tax Return - 2018 Page 5
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1400003
DR-309635
R. 01/14
Page 5
Company Name
FEIN
Collection Period Ending
(mm/dd/yy)
GALLONS
From
DIESEL
Schedule
Section I - Receipts: (see instructions)
A. Gasoline
B. Undyed Diesel
C. Dyed
D. Aviation
1.
Total product received or blended Florida
tax unpaid: ..............................................
2B.
2.
All other gallons received tax-paid (no
schedule required): ..................................
3.
Total Receipts: (Add Lines 1 and 2. Carry
forward to Line 2, Page 4.) ......................
From
Section II - Disbursements and Uses:
DIESEL
Schedule
(see instructions)
A. Gasoline
B. Undyed Diesel
C. Dyed
D. Aviation
1.
Gallons delivered or consumed subject to
additional local taxes: .............................
11/5LO.
2.
Gallons of aviation fuel converted to
highway use: ...........................................
5HW.
3.
All other gallons delivered or consumed:
(no schedule required) .............................
4.
Total disbursements: (Add
Lines 1 through 3. Carry forward to
Line 3, Page 4.) .......................................
From
DIESEL
Section III - Gasohol/Gasoline Blend
Schedule
Production:
A. Gasoline
B. Undyed Diesel
C. Dyed
D. Aviation
1.
Number of gallons of previously
taxed gasoline blended to produce
gasohol/gasoline blend not included in
Schedule 11/5LO: ...................................
2.
Number of gallons of gasohol/gasoline
blend reported on Schedule 11/5LO: ......
3.
Total gallons of gasohol/gasoline blend
produced (Add Lines 1 and 2.): ...............
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