motor vehicle fuel and aircraft - oregon · 2020. 8. 26. · jet fuel column b aviation gasoline....

MOTOR VEHICLE FUEL AND AIRCRAFT FUEL DEALER TAX REPORT

SIGNATURE

COMPANY INFORMATIONCOMPANY NAME FEIN LICENSE NUMBER TAX REPORT PERIOD

ADDRESS CITY STATE ZIP CODE

DEALER REPORTINGCOLUMN A GASOLINE

COLUMN F TOTAL

COLUMN E DIESEL

(INFORMATIONAL)

COLUMN D ETHANOL

COLUMN C JET FUEL

COLUMN B AVIATION

GASOLINE1. EX-TAX BEGINNING PHYSICAL INVENTORY (ABOVE OREGON POINT OF TAXATION) - MUST AGREE WITH PRIOR MONTH'S ENDING INVENTORY:

OREGON DEPARTMENT OF TRANSPORTATION FUELS TAX GROUP, MS 21 355 CAPITOL ST NE SALEM OR 97301-3871 PH: (503) 378-8150 OR (888) 753-2525 FAX: (503) 378-3060

SIGNATURE PRINT NAME TITLE DATE

NAME AND TITLE OF PREPARER EMAIL ADDRESS

FORM 735-1302 (4-20)

Website: http://fuelstax.oregon.gov email: [email protected]

PAGE 1

AMENDMENT

OREGON DEALER ACTIVITY SUMMARY

2. RECEIPTS (FROM PAGE 2, SECTION I, LINE 6):

3. DISBURSEMENTS (FROM PAGE 2, SECTION II, LINE 12):

4. TRANSFERS FROM ONE PRODUCT TO ANOTHER INCLUDING ETHANOL BLENDED WITH GASOLINE:

5. GAIN OR (LOSS):

6. EX-TAX ENDING PHYSICAL INVENTORY (ABOVE OREGON POINT OF TAXATION) - MUST AGREE WITH ACTUAL ENDING INVENTORY:

TAXABLE GALLONS SECTION

7. GROSS TAXABLE GALLONS (PAGE 2, SECTION II, LINE 7):

8. LESS TAX-PAID PURCHASES (PAGE 2, LINE 2 PLUS PAGE 2, LINE 11):

9. NET TAXABLE GALLONS (LINE 7 MINUS LINE 8):

TAX COMPUTATION SECTION

10. TAX RATE:

11. TAX DUE (MULTIPLY GALLONS ON LINE 9 BY THE RATE ON LINE 10):

12. INTEREST (MULTIPLY TAX ON LINE 11, COLUMN F, BY NUMBER OF DAYS LATE BY 0.000329):

13. PENALTY FOR LATE PAYMENT AT (MULTIPLY TAX ON LINE 11, COLUMN F, BY THE PENALTY RATE. IF ZERO TAX LIABILITY, THE PENALTY IS $25.00):

14. TOTAL DUE (ADD LINES 11, 12, AND 13):

15.TOTAL DUE LOCAL JURISDICTIONS (FROM PAGE 3, LINE 21):

16. GRAND TOTAL (ADD LINES 14 AND 15):

0.36 0.030.11$ $$ $

$

$

$

$

$

MAKE CHECKS PAYABLE TO THE OREGON DEPARTMENT OF TRANSPORTATION

CERTIFICATE - I HEREBY CERTIFY THAT THIS REPORT, INCLUDING THE ACCOMPANYING SCHEDULES AND STATEMENTS, IS A FULL, TRUE, AND COMPLETE REPORT OF THE NUMBER OF GALLONS SOLD, USED, AND DISTRIBUTED DURING THE MONTH ABOVE STATED BY.

MAIL REPORT AND REMITTANCE TO: ODOT FUELS TAX GROUP, UNIT 06

PO BOX 4395 PORTLAND OR 97208-4395

mailto:[email protected]

COLUMN A GASOLINE

COLUMN E DIESEL

COLUMN D ETHANOL

COLUMN C JET FUEL

COLUMN B AVIATION

GASOLINE

FROM SCHEDULE

PAGE 2





RECEIPTS: (SEE INSTRUCTIONS)

RECEIPTS AND DISBURSEMENTS SUMMARY

1. IN-STATE REFINERY PRODUCTION:

2. GALLONS RECEIVED (STATE) TAX-PAID (FORWARD AMOUNTS TO PAGE 1, LINE 8):

3. GALLONS RECEIVED FROM LICENSED DEALERS TAX-UNPAID:

4. GALLONS IMPORTED DIRECT TO CUSTOMER:

5. GALLONS IMPORTED INTO TAX-FREE STORAGE:

6. TOTAL RECEIPTS (TOTAL LINES 1 THROUGH 5):

(FORWARD TOTAL RECEIPTS ON LINE 6 TO PAGE 1, LINE 2)

1

4

3

2

SECTION I

COLUMN A GASOLINE

COLUMN E DIESEL

COLUMN D ETHANOL

COLUMN C JET FUEL

COLUMN B AVIATION

GASOLINE

FROM SCHEDULE

DISBURSEMENTS: (SEE INSTRUCTIONS)

5 / 5LO

8

7

6

SECTION II

7. GALLONS DELIVERED TAX COLLECTED (FORWARD AMOUNTS TO PAGE 1, LINE 7):

8. GALLONS DELIVERED TO LICENSED DEALERS TAX NOT COLLECTED:

9. GALLONS EXPORTED:

10. GALLONS DELIVERED TO U.S. GOVERNMENT TAX-EXEMPT:

11. GALLONS DELIVERED TO DIPLOMATS:

12. TOTAL DISBURSEMENTS (TOTAL LINES 7 THROUGH 10):

(FORWARD DISBURSEMENTS ON LINE 12 TO PAGE 1, LINE 3)

FORM 735-1302 (4-20)

10D









FORM 735-1302 (4-20)

COLUMN A LOCAL JURISDICTION

COLUMN FRATE

COLUMN I INTEREST

COLUMN H PENALTY

COLUMN G AMOUNT DUE

(COLUMN E * RATE)

COLUMN E TAXABLE GALLONS (COLUMN B MINUS COLUMN C AND D)

COLUMN D DEDUCTIONS

(FROM SCHEDULES 7E, 10AC, 10AD, AND 10)

COLUMN C TAX PAID PURCHASES (FROM SCHEDULE 1H)

COLUMN B SALES IN

JURISDICTION (FROM SCHEDULE 5LO)

-

-

-

1. CITY OF ASTORIA

21. TOTAL TAX, PENALTY, INTEREST (FORWARD TO PAGE 1, LINE 15)

20. TOTALS

19. WASHINGTON COUNTY

18. MULTNOMAH COUNTY

17. CITY OF WOODBURN

16. CITY OF WARRENTON

15. CITY OF VENETA

13. CITY OF TIGARD

0.0314. CITY OF TROUTDALE

12. CITY OF SPRINGFIELD

9. CITY OF NEWPORT

11. CITY OF REEDSPORT

10. CITY OF PORTLAND

8. CITY OF MILWAUKIE

7. CITY OF HOOD RIVER

6. CITY OF EUGENE

5. CITY OF COTTAGE GROVE

4. CITY OF COQUILLE

3. CITY OF COBURG

2. CITY OF CANBY

0.03-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

0.01

0.03

0.01

0.03

0.03

0.03

0.03

0.030.02

0.03

0.05

0.03

0.03

0.06

0.03

$

$

$$$

$$$

$$$

$

$$$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$



0.01

0.100.030.00


SCHEDULE OF RECEIPTS (1, 1H, 2, 3, and 4)

COMPANY NAME FEIN TAX REPORT PERIOD SCHEDULE CODELICENSE NUMBER PRODUCT CODE




(1) CARRIER

NAME

(12) BILLED

GALLONS

(11) GROSS

GALLONS

(10) NET

GALLONS

(9) DOCUMENT

NUMBER

(8) DATE

RECEIVED

(7) SELLER'S

FEIN

(6) SELLER NAME

(5) POINT OF

DESTINATION

(4) POINT OF

ORIGIN

(3) MODE

(2) CARRIER

FEIN

TOTAL

COMPANY INFORMATION

FORM 735-1302 (4-20)



PAGE 4


SCHEDULE OF DISBURSEMENTS (5, 5LO, 6, 7, 7E, 8, 10, 10AC, and 10AD)



COMPANY NAME FEIN TAX REPORT PERIOD SCHEDULE CODE PRODUCT CODELICENSE NUMBER

(1) CARRIER

NAME

(12) BILLED

GALLONS

(11) GROSS

GALLONS

(10) NET

GALLONS

(9) DOCUMENT

NUMBER

(8) DATE

SHIPPED

(7) BUYER'S

FEIN

(6) BUYER NAME

(5) POINT OF

DESTINATION

(4) POINT OF

ORIGIN

(3) MODE

(2) CARRIER

FEIN

TOTAL


COMPANY INFORMATION

FORM 735-1302 (4-20)



PAGE 5


1.4

735-9684 (7-06)

Connie Borgelt

PrintMonitor

Acrobat Distiller 7.0.5 (Windows)

D:20060526085924-07'00'

D:20060607104033-07'00'

MOTOR VEHICLE FUEL AND AIRCRAFT

FUEL DEALER TAX REPORT

SIGNATURE

COMPANY INFORMATION

DEALER REPORTING

COLUMN A

GASOLINE

COLUMN F

TOTAL

COLUMN E

DIESEL

(INFORMATIONAL)

COLUMN D

ETHANOL

COLUMN C

JET FUEL

COLUMN B

AVIATION

GASOLINE

1. EX-TAX BEGINNING PHYSICAL INVENTORY (ABOVE OREGON POINT OF

TAXATION) - MUST AGREE WITH PRIOR MONTH'S ENDING INVENTORY:

OREGON DEPARTMENT OF TRANSPORTATION

FUELS TAX GROUP, MS 21

355 CAPITOL ST NE

SALEM OR 97301-3871

PH: (503) 378-8150 OR (888) 753-2525

FAX: (503) 378-3060

FORM 735-1302 (4-20)

Website: http://fuelstax.oregon.gov

email: [email protected]

PAGE 1

AMENDMENT

OREGON DEALER ACTIVITY SUMMARY

2. RECEIPTS (FROM PAGE 2, SECTION I, LINE 6):

3. DISBURSEMENTS (FROM PAGE 2, SECTION II, LINE 12):

4. TRANSFERS FROM ONE PRODUCT TO ANOTHER INCLUDING ETHANOL

BLENDED WITH GASOLINE:

5. GAIN OR (LOSS):

6. EX-TAX ENDING PHYSICAL INVENTORY (ABOVE OREGON POINT OF

TAXATION) - MUST AGREE WITH ACTUAL ENDING INVENTORY:

TAXABLE GALLONS SECTION

7. GROSS TAXABLE GALLONS (PAGE 2, SECTION II, LINE 7):

8. LESS TAX-PAID PURCHASES (PAGE 2, LINE 2 PLUS PAGE 2, LINE 11):

9. NET TAXABLE GALLONS (LINE 7 MINUS LINE 8):

TAX COMPUTATION SECTION

10. TAX RATE:

11. TAX DUE (MULTIPLY GALLONS ON LINE 9 BY THE RATE ON LINE 10):

12. INTEREST (MULTIPLY TAX ON LINE 11, COLUMN F, BY NUMBER OF DAYS LATE BY 0.000329):

13. PENALTY FOR LATE PAYMENT AT (MULTIPLY TAX ON LINE 11, COLUMN F, BY THE PENALTY RATE. IF ZERO TAX LIABILITY, THE PENALTY IS $25.00):

14. TOTAL DUE (ADD LINES 11, 12, AND 13):

15.TOTAL DUE LOCAL JURISDICTIONS (FROM PAGE 3, LINE 21):

16. GRAND TOTAL (ADD LINES 14 AND 15):

0.36

0.03

0.11

$

$

$

$

$

$

$

$

$

MAKE CHECKS PAYABLE TO THE OREGON DEPARTMENT OF TRANSPORTATION

CERTIFICATE - I HEREBY CERTIFY THAT THIS REPORT, INCLUDING THE ACCOMPANYING SCHEDULES AND STATEMENTS, IS A FULL, TRUE, AND COMPLETE REPORT OF THE NUMBER OF GALLONS SOLD, USED, AND DISTRIBUTED DURING THE MONTH ABOVE STATED BY.

MAIL REPORT AND REMITTANCE TO:

ODOT FUELS TAX GROUP, UNIT 06

PO BOX 4395

PORTLAND OR 97208-4395

COLUMN A

GASOLINE

COLUMN E

DIESEL

COLUMN D

ETHANOL

COLUMN C

JET FUEL

COLUMN B

AVIATION

GASOLINE

FROM SCHEDULE

PAGE 2



COMPANY INFORMATION



355 CAPITOL ST NE

SALEM OR 97301-3871

PH: (503) 378-8150 OR (888) 753-2525

FAX: (503) 378-3060



RECEIPTS: (SEE INSTRUCTIONS)


1. IN-STATE REFINERY PRODUCTION:

2. GALLONS RECEIVED (STATE) TAX-PAID (FORWARD AMOUNTS TO PAGE 1, LINE 8):

3. GALLONS RECEIVED FROM LICENSED DEALERS TAX-UNPAID:

4. GALLONS IMPORTED DIRECT TO CUSTOMER:

5. GALLONS IMPORTED INTO TAX-FREE STORAGE:

6. TOTAL RECEIPTS (TOTAL LINES 1 THROUGH 5):

(FORWARD TOTAL RECEIPTS ON LINE 6 TO PAGE 1, LINE 2)

1

4

3

2

SECTION I

COLUMN A

GASOLINE

COLUMN E

DIESEL

COLUMN D

ETHANOL

COLUMN C

JET FUEL

COLUMN B

AVIATION

GASOLINE

FROM SCHEDULE

DISBURSEMENTS: (SEE INSTRUCTIONS)

5 / 5LO

8

7

6

SECTION II

7. GALLONS DELIVERED TAX COLLECTED (FORWARD AMOUNTS TO PAGE 1, LINE 7):

8. GALLONS DELIVERED TO LICENSED DEALERS TAX NOT COLLECTED:

9. GALLONS EXPORTED:

10. GALLONS DELIVERED TO U.S. GOVERNMENT TAX-EXEMPT:

11. GALLONS DELIVERED TO DIPLOMATS:

12. TOTAL DISBURSEMENTS (TOTAL LINES 7 THROUGH 10):

(FORWARD DISBURSEMENTS ON LINE 12 TO PAGE 1, LINE 3)

FORM 735-1302 (4-20)

10D



PO BOX 4395


PAGE 3



COMPANY INFORMATION



355 CAPITOL ST NE

SALEM OR 97301-3871

PH: (503) 378-8150 OR (888) 753-2525

FAX: (503) 378-3060




FORM 735-1302 (4-20)

COLUMN A

LOCAL JURISDICTION

COLUMN F

RATE

COLUMN I

INTEREST

COLUMN H

PENALTY

COLUMN G

AMOUNT DUE

(COLUMN E * RATE)

COLUMN E

TAXABLE GALLONS

(COLUMN B MINUS

COLUMN C AND D)

COLUMN D

DEDUCTIONS

(FROM SCHEDULES

7E, 10AC, 10AD, AND 10)

COLUMN C

TAX PAID PURCHASES

(FROM SCHEDULE 1H)

COLUMN B

SALES IN

JURISDICTION

(FROM SCHEDULE 5LO)

-

-

-

1. CITY OF ASTORIA

21. TOTAL TAX, PENALTY, INTEREST (FORWARD TO PAGE 1, LINE 15)

20. TOTALS

19. WASHINGTON COUNTY

18. MULTNOMAH COUNTY

17. CITY OF WOODBURN

16. CITY OF WARRENTON

15. CITY OF VENETA

13. CITY OF TIGARD

0.03

14. CITY OF TROUTDALE

12. CITY OF SPRINGFIELD

9. CITY OF NEWPORT

11. CITY OF REEDSPORT

10. CITY OF PORTLAND

8. CITY OF MILWAUKIE

7. CITY OF HOOD RIVER

6. CITY OF EUGENE

5. CITY OF COTTAGE GROVE

4. CITY OF COQUILLE

3. CITY OF COBURG

2. CITY OF CANBY

0.03

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

0.01

0.03

0.01

0.03

0.03

0.03

0.03

0.03

0.02

0.03

0.05

0.03

0.03

0.06

0.03

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$



PO BOX 4395


0.01

0.10

0.03

0.00

SCHEDULE OF RECEIPTS (1, 1H, 2, 3, and 4)





355 CAPITOL ST NE

SALEM OR 97301-3871

PH: (503) 378-8150 OR (888) 753-2525

FAX: (503) 378-3060



(1)

CARRIER

NAME

(12)

BILLED

GALLONS

(11)

GROSS

GALLONS

(10)

NET

GALLONS

(9)

DOCUMENT

NUMBER

(8)

DATE

RECEIVED

(7)

SELLER'S

FEIN

(6)

SELLER

NAME

(5)

POINT OF

DESTINATION

(4)

POINT OF

ORIGIN

(3)

MODE

(2)

CARRIER

FEIN

TOTAL

COMPANY INFORMATION

FORM 735-1302 (4-20)



PO BOX 4395


PAGE 4

SCHEDULE OF DISBURSEMENTS (5, 5LO, 6, 7, 7E, 8, 10, 10AC, and 10AD)





355 CAPITOL ST NE

SALEM OR 97301-3871

PH: (503) 378-8150 OR (888) 753-2525

FAX: (503) 378-3060

(1)

CARRIER

NAME

(12)

BILLED

GALLONS

(11)

GROSS

GALLONS

(10)

NET

GALLONS

(9)

DOCUMENT

NUMBER

(8)

DATE

SHIPPED

(7)

BUYER'S

FEIN

(6)

BUYER

NAME

(5)

POINT OF

DESTINATION

(4)

POINT OF

ORIGIN

(3)

MODE

(2)

CARRIER

FEIN

TOTAL



COMPANY INFORMATION

FORM 735-1302 (4-20)



PO BOX 4395


PAGE 5

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motor vehicle fuel and aircraft - oregon · 2020. 8. 26. · jet fuel column b aviation gasoline....

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