Form Dr-309632 Draft - Wholesaler/importer Fuel Tax Return - 2018 Page 5
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1400003
DR-309632
R. 01/14
Page 5
Company Name
FEIN
Collection Period Ending
(mm/dd/yy)
Enter the total gallons from each receipt and disbursement schedule on this page. Report receipts and disbursements in
whole net gallons
GALLONS
DIESEL
From
Schedule
A. Gasoline
D. Aviation
B. Undyed
C. Dyed
Section I - Receipts: (see instructions)
1A
1.
Gallons received - Florida tax paid: ..........
2.
Gallons received from supplier for export -
1B
other state’s tax paid: ................................
3.
Gallons received - tax unpaid
2A
(imports): ...................................................
4.
Total product received or blended - Florida
2B
tax unpaid: ................................................
5.
Taxable receipts: (Line 3 plus Line 4. Carry
to Page 4, Line 7.) .....................................
6.
Total receipts: (Carry to Page 4,
Line 2.) .......................................................
DIESEL
From
A. Gasoline
D. Aviation
B. Undyed
C. Dyed
Schedule
Section II - Disbursements: (see instructions)
11/
1.
Gallons gasoline delivered - all taxes
5LO
collected (state and local option taxes): ...
2.
Gallons diesel delivered - all taxes
5A
collected (state & local option taxes): .......
3.
Gallons delivered - Florida state
5B
tax only collected: .....................................
4.
Gallons aviation converted for
5HW
highway use: .............................................
5.
Gallons exported by other than
7A
bulk transfer: .............................................
6.
Gallons exported - other state’s tax
7B
paid to supplier: ........................................
7.
Gallons delivered To U.S. Government
8
(500 gallons or more): ................................
8.
Gallons of undyed diesel, jet fuel or
10
aviation gasoline delivered to other tax
exempt entities: .........................................
9.
Total disbursements:
(Add Lines 1 through 8. Carry to Page 4,
Line 3.) .......................................................
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