Free DR-309632 - Florida

Wholesaler/Importer Fuel Tax Return

DR-309632 R. 01/09 page 1
Rule 12B-5.150 Florida Administrative Code Effective 06/09

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Complete and return coupon to the Department of Revenue.

IMPORTANT

COMPLETE FORM DR-309632 BEFORE ENTERING INFORMATION ON THE ATTACHED COUPON.
Mail the original of this form along with coupon to the: Florida Department of Revenue 5050 W Tennessee St Tallahassee Fl 32399-0165
Detach here
Mail To: Florida Department of Revenue 5050 W Tennessee St Tallahassee FL 32399-0165

Detach here

Wholesaler/Importer Fuel Tax Return Coupon
COMPLETE and MAIL with your RETURN/PAYMENT. Please write your Federal Employer Identification Number (FEIN) on check. Be sure to SIGN YOUR CHECK. Make check payable to: Florida Department of Revenue

DR-309632 R. 01/09

DoR USE oNly
poSTMARk oR hAND DElIvERy DATE

FEIN ENTER BUSINESS NAME: AMoUNT DUE FRoM lINE 30 IF CREDIT DUE ENTER 0 FoR CollECTIoN pERIoD ENDINg

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US Dollars

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Cents

DR-309632
Do Not Write in the Space Below

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DR-309632 R. 01/09 page 2

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Mail To: Florida Department of Revenue 5050 W Tennessee St Tallahassee FL 32399-0165

Wholesaler/Importer Fuel Tax Return

DR-309632 R. 01/09 page 3

Check here if amending return
FEIN: License Number: Collection Period Ending:

Return Due By

Late After

Complete Reverse Side of Return First
24. Combined gasoline, diesel, and aviation fuel tax due: (Page 4, Line 24) ................................................ 24. _________________________

CREDITS
25. 26. Ultimate vendor credits: From ultimate vendor credit worksheet (Page 13, Line 25) ........... 25. _______________________ Credit memos issued by the Department of Revenue: ......................................................... 26. _______________________

ToTAl DUE WITh RETURN CAlCUlATIoN
27. 28. 29. 30. Tax due with return: (Line 24 minus Lines 25 and 26) ............................................................................. 27. _________________________ Penalty: (10% - see instructions) ............................................................................................................. 28. _________________________ Interest: (Market rate - see instructions) .................................................................................................. 29. _________________________ Total due with return: (Line 27 plus Line 28 plus Line 29) ........................................................................ 30. _________________________



Check here if you have electronically transmitted funds

Under penalties of perjury, I swear or affirm that this return, including any accompanying schedules and statements, has been examined by me and it is true, correct and complete for the collection period stated.

_______________________________________________________________________________________________________________________
Signature of Officer/Owner Title Date

_______________________________________________________________________________________________________________________
Name of Preparer (Print) Signature of Preparer Telephone Number FEIN Date

DR-309632 R. 01/09 page 4
Company Name FEIN Collection Period Ending (mm/dd/yy)

A. Gasoline
1. Beginning physical inventory: ............................ 2. Receipts: (Page 5, Section I, Line 6) .................. 3. Disbursements: (Page 5, Section II, Line 9) ......... 4. Transfers: ............................................................ 5. Gain or (Loss): .................................................... 6. Ending physical inventory: ................................. 7. Net taxable gallons: (Page 5, Section I, Line 5) ..... State Tax Calculations 8. Gasoline (Line 7, Column A times 0000), and Diesel: (Line 7, Column B times 0000) ............... 9. Aviation: (Line 7, Column D times 0000) ............ 10. Collection allowance Gasoline: (Line 8, Column A times 0000000) Aviation: (Line 9, Column D times 0000) ............ 11. Collection allowance Diesel: (Line 8, Column B times 0000000) ......... 12. Net state fuel tax due: ........................................ local option - Tax and Collection Allowance Calculations - gasoline 13. Local option tax entitled to collection allowance - Gasoline: (Schedule 11, Page 12, Column C total) ............ 14. Collection allowance - gasoline local option tax: (Line 13, Column A times 0000) ....... 15. Local option tax not entitled to collection allowance - Gasoline: (Schedule 11, Page 12, Column E total) ................................... 16. Total local option tax due - Gasoline: (Line 13 minus Line 14 plus Line 15) .................. local option - Tax and Collection Allowance Calculation - Diesel 17. Local option tax entitled to collection allowance - Diesel: (Line 7, Column B times 0000) ........................... 18. Collection allowance - diesel local option tax: (Line 17 times 0000) ......................... 19. Local option tax not entitled to collection allowance - Diesel: (Line 7, Column B times 0000) ........................... 20. Total local option tax due - Diesel: (Line 17 minus Line 18 plus Line 19) .................. Total State and local option Tax Due Calculations 21. Total tax due - Gasoline: (Line 12, Column A plus Line 16, Column A) ..................................... 22. Total tax due - Diesel: (Line 12, Column B plus Line 20, Column B) ............................................. 23. Total tax due - Aviation: (Line 12, Column D) ............................................

gAlloNS DIESEL B. Undyed C. Dyed

D. Aviation

DollARS

A. Gasoline

B. Undyed

DIESEL C. Dyed

D. Aviation

24. Combined gasoline, diesel, and aviation fuel tax due: (Add Lines 21, 22, and 23. Carry to Page 3, Line 24.) ......

DR-309632 R. 01/09 page 5
Company Name FEIN Collection Period Ending (mm/dd/yy)

Report receipts and disbursements in whole net gallons
From Schedule

A. Gasoline

gAlloNS DIESEL B. Undyed C. Dyed

D. Aviation

Section I - Receipts: (see instructions) 1. Gallons received - Florida tax paid: .......... 2. Gallons received from supplier for export other state's tax paid: ................................ 3. Gallons received - tax unpaid (imports): ................................................... 4. Total product received or blended - Florida 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.) ....................................................... Section II - Disbursements: (see instructions) 1. Gallons gasoline delivered - all taxes collected (state and local option taxes): ... 2. Gallons diesel delivered - all taxes collected (state & local option taxes): ....... 3. Gallons delivered - Florida state tax only collected: ..................................... 4. Gallons aviation converted for highway use: ............................................. 5. Gallons exported by other than bulk transfer: ............................................. 6. Gallons exported - other state's tax paid to supplier: ........................................ 7. Gallons delivered To U.S. Government (500 gallons or more): ................................ 8. Gallons of undyed diesel/jet fuel delivered to other tax exempt entities: ....... 9. Total disbursements: (Add Lines 1 through 8. Carry to Page 4, Line 3.) .......................................................

1A 1B 2A 2B

From Schedule

A. Gasoline

B. Undyed

DIESEL

C. Dyed

D. Aviation

11/ 5LO 5A 5B 5HW 7A 7B 8 10

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DR-309632 R. 01/09 page 6

Wholesaler -- Schedule of Receipts

Check here if amending schedule
FEIN Collection Period Ending (mm/dd/yy)

Schedule/Product Type

Company Name

DR-309632 R. 01/09 page 7

Schedule Type - only one product type per schedule:
065 072 124 125 130 142 Gasoline Dyed Kerosene Gasohol Aviation Gasoline jet Fuel Undyed Kerosene 167 Low Sulphur Diesel #2/ Undyed/Blended Biodiesel (B20, B10, B5, B2) 224 Compressed Natural Gas/ Propane 226 High Sulphur Diesel Fuel Dyed

product Type:
227 Low Sulphur Diesel Fuel - Dyed B00 Undyed/Unblended Biodiesel (B100) D00 Dyed Biodiesel (B100) E00 Ethanol (percent of ethanol equals 99.1% or more)

1A. 1B. 2A. 2B.

Gallons Received - Florida Tax Paid Gallons Received From Supplier For Export - Other States Taxes Paid Gallons Received - Tax Unpaid (Imports) Total Product Received or Blended - Florida Tax Unpaid

(1) Carrier's Name Origin Destination (5) Seller's Name (6) Seller's FEIN

(2) Carrier's FEIN (3) Mode

(4) Point of Acquired From

(7) Date Received

(8) Document Number

(10) (11) (9) Gross Billed Net Gallons Gal- Gallons lons

Subtotal

Wholesaler -- Schedule of Receipts (continued)
FEIN Collection Period Ending (mm/dd/yy)

Schedule/Product Type

Company Name

DR-309632 R. 01/09 page 8

(1) Carrier's Name Origin Destination (5) Seller's Name (6) Seller's FEIN

(2) Carrier's FEIN (3) Mode

(4) Point of Acquired From

(10) (11) (7) (8) (9) Gross Billed Date Document Net Gallons Gal- GalReceived Number lons lons

Total

Wholesaler-- Schedule of Disbursements

Check here if amending schedule
FEIN Collection Period Ending (mm/dd/yy)

Schedule/Product Type

Company Name

DR-309632 R. 01/09 page 9

Schedule Type - only one product type per schedule: Use Schedule 11 to report gallons of gasoline delivered - all tax collected. product Type:
065 072 124 125 130 142 Gasoline Dyed Kerosene Gasohol Aviation Gasoline jet Fuel Undyed Kerosene 167 Low Sulphur Diesel #2/ Undyed/Blended Biodiesel (B20, B10, B5, B2) 224 Compressed Natural Gas/ Propane 226 High Sulphur Diesel Fuel Dyed 227 Low Sulphur Diesel Fuel - Dyed B00 Undyed/Unblended Biodiesel (B100) D00 Dyed Biodiesel (B100) E00 Ethanol (percent of ethanol equals 99.1% or more)

5A. 5B. 5HW. 5LO. 7A. 7B. 8. 10.

Gallons Diesel Delivered - All Taxes Collected (State and Local) Gallons Delivered - State Tax Collected (Gasoline/Aviation) Gallons of Aviation Fuel Converted for Highway use Gallons of Gasoline/Gasohol Delivered to Retail Locations and End-users Gallons Exported by Other Than Bulk Transfer Gallons Exported - Other State's Tax Paid to Supplier Gallons Delivered to U.S. Government - Tax Exempt (500 Gallons or More) Gallons of Undyed Diesel/Jet Fuel Delivered to Other Tax - exempt Entities

(1) Carrier's Name Origin Destination (6) Purchaser's Name

(2) Carrier's FEIN (3) Mode (7) Purchaser's FEIN

(4) Point of (5) T erm. Code Sold To

(8) Date Shipped

(9) Document Number

(11) (12) (10) Gross Billed Net Gallons Gal- Gallons lons

Subtotal

Wholesaler-- Schedule of Disbursements (continued)
FEIN Collection Period Ending (mm/dd/yy)

Schedule/Product Type

Company Name

DR-309632 R. 01/09 page 10

(1) Carrier's Name Origin Destination (6) Purchaser's Name

(2) Carrier's FEIN

(3) Mode

(4) Point of (5) T erm. Code Sold To

(11) (12) (8) (9) (10) Gross Billed Date Document Net Gallons Gal- Gal(7) Shipped Number lons lons Purchaser's FEIN

Total

Check here if amending schedule
Schedule 11 -- Retail local option tax worksheet for summarizing by county gasoline/gasohol gallons delivered to retail locations and end-users (local option tax collected) product Type: 065 -- gasoline 124 -- gasohol
Schedule/Product Type Company Name FEIN

DR-309632 R. 01/09 page 11

Collection Period Ending (mm/dd/yy)

11/ (A) Gallons of Gasoline or Gasohol Sold (B) (C) Local Option Tax Entitled to Collection Allowance (A) times (B) = (C) (D) SCETS/ Additional Local Option Rate (E) Local Option Tax Not Entitled to Collection Allowance (A) times (D) = (E)

County

Rate Entitled to Collection Allowance

01 02 03 04 05 06 07 08 09 10 11 12 13

Alachua Baker Bay Bradford Brevard Broward Calhoun Charlotte Citrus Clay Collier Columbia Dade (Miami-Dade)

14 De Soto 15 Dixie 16 Duval 17 Escambia 18 Flagler 19 Franklin 20 Gadsden 21 Gilchrist 22 Glades 23 Gulf 24 Hamilton 25 Hardee 26 Hendry 27 Hernando 28 Highlands 29 Hillsborough 30 Holmes 31 Indian River 32 jackson 33 jefferson Page 11 Subtotal

DR-309632 R. 01/09 page 12

Schedule 11 -- Continuation of retail local option tax worksheet for summarizing by county gasoline/ gasohol gallons delivered to retail locations and end-users (local option tax collected)
Schedule/Product Type Company Name FEIN

11/ (A) Gallons of Gasoline or Gasohol Sold (B) (C) Local Option Tax Entitled to Collection Allowance (A) times (B) = (C) (D) SCETS/ Additional Local Option Rate

Collection Period Ending (mm/dd/yy)

County

Rate Entitled to Collection Allowance

(E) Local Option Tax Not Entitled to Collection Allowance (A) times (D) = (E)

34 Lafayette 35 Lake 36 Lee 37 Leon 38 Levy 39 Liberty 40 Madison 41 Manatee 42 Marion 43 Martin 44 Monroe 45 Nassau 46 Okaloosa 47 Okeechobee 48 Orange 49 Osceola 50 Palm Beach 51 Pasco 52 Pinellas 53 Polk 54 Putnam 55 St. johns 56 St. Lucie 57 Santa Rosa 58 Sarasota 59 Seminole 60 Sumter 61 Suwannee 62 Taylor 63 Union 64 Volusia 65 Wakulla 66 Walton 67 Washington Page 12 Subtotal
Subtotal from Page 11

Total

Check here if amending schedule
Schedule 12 -- Ultimate vendor credits worksheet for reporting deliveries and exports of tax paid fuel to consumers who qualify to purchase fuel tax-exempt
Schedule Company Name FEIN

DR-309632 R. 01/09 page 13

12/ gAlloNS DIESEL B. Undyed

Collection Period Ending (mm/dd/yy)

A. Gasoline
1. Total gallons delivered to other tax exempt entities (Schedule 10): ......................................... 2. Total gallons delivered to U.S. Government tax exempt - 500 gallons or more (Schedule 8): ....... 3. Total gallons exported by other than bulk transfer: (Schedule 7A): ............................... 4. Total gallons tax paid aviation fuel converted for highway use (Schedule 5HW): ............................ 5. Total gallons qualifying for credit: (Add Lines 1,2,3, and 4) ...................................... 6. State fuel tax rate: ............................................. 7. State tax due: (Line 5 times Line 6) ..................... 8. Collection allowance rates for state tax: ........... 9. State tax collection allowance calculation: (Line 7 times Line 8) ......................... 10. Local option rate entitled to collection allowance: ........................................................... 11. Portion of local option tax entitled to collection allowance: (Line 5, Column B times Line 10) ...... 12. Local option collection allowance rate: ............... 13. Local option collection allowance calculation: (Line 11 times Line 12) ..................... 14. Local option tax rate not entitled to collection allowance: ........................................... 15. Portion of local option tax not entitled to collection allowance: (Line 5, Column B times Line 14) ....... 16. Ultimate vendor credit calculation: A. Gasoline: (Line 7 minus Line 9) ....................... B. Diesel: (Line 7 minus Line 9 plus Line 11 minus Line 13 plus Line 15) ............................ C. Aviation: (Line 7 minus Line 9) ........................ Shared Collection Allowance Add-back 17. Enter the amount from Line 5 above (total gallons qualifying for credit): ............................................ 18. Enter the amount from Line 7, Page 4 of this return (net taxable gallons): ................................. 19. Gallons subject to shared collection allowance calculation: (Line 17 minus 18). If negative enter and skip to Line 24 .............................................. 20. State fuel tax rate: ............................................... 21. Tax subject to shared collection allowance: (Line 19 times Line 20) ........................................ 22. Shared collection allowance add-back rates: ..... 23. Shared collection allowance add-back: (Line 21 times Line 22) ......................................... 24. Allowable ultimate vendor credit A. Gasoline: (Line 16A plus Line 23A) ................. B. Diesel: (Line 16B plus Line 23B) ..................... C. Aviation: (Line 16C plus Line 23C) ..................

C. Dyed

D. Aviation

25. Total ultimate vendor credit amount: (Add Line 24A, Line 24B, and Line 24C. Carry forward to Page 3, Line 25.) . .......

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DR-309632 R. 01/09 page 14