Free DR-309638 - Florida

Exporter Fuel Tax Return

DR-309638 R. 01/09 page 1
Rule 12B-5.150 Florida administrative Code Effective 06/09

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Handwritten Example

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Typed Example

Use black ink.

Complete and return coupon to the Department of Revenue.

IMPORTANT

COMPLETE FORM DR-309638 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

Exporter Fuel Tax Return Coupon
COMPLETE and MAIL with your RETURN DoR usE only
posTmaRk oR hanD DElivERy DaTE

DR-309638 R. 01/09

FEin EnTER BusinEss namE:

Do Not Write in the Space Below

DR-309638

FoR CollECTion pERioD EnDing

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DR-309638 R. 01/09 page 2

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Internet Address: www.myflorida.com/dor

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

Exporter Fuel Tax Return

DR-309638 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

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 Exporter Title Date

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

DR-309638 R. 01/09 page 4
Company Name FEIN Collection Period Ending (mm/dd/yy)

gallons
DiESEL

A. Gasoline
1. Gallons exported - Florida tax paid. (Schedule 1A): ............................................ 2. Gallons exported - other state tax paid to Florida supplier (Schedule 1B): ................... 3. Gallons exported - tax unpaid. (Schedule 1C): ............................................

B. Undyed

C. Dyed

D. Aviation

schedule of Exports

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

Schedule/Product Type

Company Name

DR-309638 R. 01/09 page 5

schedule Type: product Type:
227 Low Sulphur Diesel Fuel - Dyed B00 Undyed/Unblended Biodiesel (B100) D00 Dyed Biodiesel (B100)

1A.

Gallons Received/Exported - Florida Tax Paid

1B.

Gallons Received/Exported - Other State Tax Paid

1C.

Gallons Received/Exported - Florida Tax Unpaid (Dyed Diesel)

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

(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

schedule of Exports (continued)
FEIN Collection Period Ending (mm/dd/yy)

Schedule/Product Type

Company Name

DR-309638 R. 01/09 page 6

(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