Terminal Supplier Test Script -...
20
Florida Department of Revenue Business Technology Office EXD‐[email protected] Terminal Supplier Test Script Licensed terminal suppliers must begin filing electronically with the Florida Department of Revenue within 90 days of notification by the Department. New terminal suppliers, or a company converting from a licensed wholesaler to a terminal supplier, are required to successfully submit test files to the Department before filing electronically. The testing process begins after completion of all registration requirements and receipt of an electronic filer 90‐day notice from the Department. The purpose of testing is to verify that your electronic filing system is mapping data correctly to produce valid tax returns. Testing procedures are outlined in the Motor Fuels Technical EDI Implementation Guide. Taxpayers who do not have transactional detail (i.e., file zero returns) should use the following test return to create an electronic test file. When creating a test file, the following areas should contain your actual business information: FEI Number Company/ Business Name License Number Current Collection Period Ending Once you have created an electronic test file, upload it to the SecureNet website as “Test Only.” The Department will compare your electronic submission against our test return and provide results in an e‐ mail. Taxpayers who have transactional detail (receipts or disbursements) should not use this test return. Instead, produce two electronic returns containing the data from two reporting period paper returns. Upload the electronic files to the SecureNet website as “Test Only.” The Department will compare the electronically filed test returns against the paper returns submitted for the same reporting periods. If you are unable to complete your testing process within 90 days, you may ask for an extension of time by submitting a written request to EXD‐[email protected]. If you have any questions or need assistance, please email us at EXD‐[email protected].
Transcript of Terminal Supplier Test Script -...
Florida Department of Revenue Business Technology Office EXD‐[email protected]
Terminal Supplier Test Script
Licensed terminal suppliers must begin filing electronically with the Florida Department of Revenue
within 90 days of notification by the Department. New terminal suppliers, or a company converting
from a licensed wholesaler to a terminal supplier, are required to successfully submit test files to the
Department before filing electronically.
The testing process begins after completion of all registration requirements and receipt of an electronic
filer 90‐day notice from the Department. The purpose of testing is to verify that your electronic filing
system is mapping data correctly to produce valid tax returns. Testing procedures are outlined in the
Motor Fuels Technical EDI Implementation Guide.
Taxpayers who do not have transactional detail (i.e., file zero returns) should use the following test
return to create an electronic test file. When creating a test file, the following areas should contain your
actual business information:
FEI Number
Company/ Business Name
License Number
Current Collection Period Ending
Once you have created an electronic test file, upload it to the SecureNet website as “Test Only.” The
Department will compare your electronic submission against our test return and provide results in an e‐
mail.
Taxpayers who have transactional detail (receipts or disbursements) should not use this test return.
Instead, produce two electronic returns containing the data from two reporting period paper returns.
Upload the electronic files to the SecureNet website as “Test Only.” The Department will compare the
electronically filed test returns against the paper returns submitted for the same reporting periods.
If you are unable to complete your testing process within 90 days, you may ask for an extension of time
by submitting a written request to EXD‐[email protected].
If you have any questions or need assistance, please email us at EXD‐[email protected].
FEIN
ENTER BUSINESS NAME:
Terminal Supplier Fuel Tax Return Coupon DR-309631
R. 01/14
FOR COLLECTION
PERIOD ENDING YYM M D D
Mail the original of this form along with coupon
to the:
Florida Department of Revenue 5050 W Tennessee St Tallahassee FL 32399-0165
Terminal Supplier Fuel Tax Return
DR-309631
COMPLETE FORM DR-309631 BEFORE ENTERING INFORMATION
ON THE ATTACHED COUPON.
AMOUNT DUE
FROM LINE 33
IF CREDIT DUE ENTER 0 ,,US Dollars Cents
Mail To:Florida Department of Revenue5050 W Tennessee StTallahassee FL 32399-0165
Detach
hereDetach
here
Do Not Write in the Space Below.
DR-309631
R. 01/14
TCRule 12B-5.150
Florida Administrative Code
Effective 01/14
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
IMPORTANTComplete and return
coupon to the Department of Revenue.
0 1 2 3 4 5 6 7 8 9 0123456789Use black ink.
Handwritten Example Typed Example
Name
Address
City/St/ZIP
For Calendar Year
For Calendar Year 2017
2017
9200 0 20179999 0091027031 8 3000000001 0000 2
dr309631 testscript Pg. 3
dr309631 testscript Pg. 2
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dr309631 testscript Pg. 3
DR-309631
R. 01/14
The following pages have intentionally been omitted from this document
Pages 2, 6, 14 and 18 - blank pages
Pages 8, 10 and 16 - continuation of schedules
Pages 11 and 12 - summary worksheet for schedule 11 (replaced by 5LO)
Pages 15 (schedule 13F) and 17 (schedule 13B)
A header page that provides testing information and this description page
Two pages have been added to this document
Test Scrip
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Terminal Supplier
Fuel Tax Return
Complete Reverse Side of Return First
26. Combined gasoline, diesel and aviation fuel tax due: (Page 4, Line 26) ........................................26. _________________________
CREDITS27. Ultimate vendor credits:
From ultimate vendor credit worksheet (Page 13, Line 25) ............27. _________________________
28. Credit memos issued by the Department of Revenue: ...................28. _________________________
29. Other allowed credits: (Page 17, Line 15) .......................................29. _________________________
TOTAL DUE WITH RETURN CALCULATION30. Tax due with return: (Line 26 minus Lines 27 through 29) ..............................................................30. _________________________
31. Penalty: ...........................................................................................................................................31. _________________________
32. Interest: ...........................................................................................................................................32. _________________________
33. Total due with return: (Line 30 plus Line 31 plus Line 32) ...............................................................33. _________________________
Check here if you have electronically transmitted funds
Under penalty of perjury, I declare that I have read this return and the facts stated in it are true.
_______________________________________________________________________________________________________________________Signature of Officer/Owner Title Date
_______________________________________________________________________________________________________________________Name of Preparer (Print) Signature of Preparer Telephone Number FEIN Date
DR-309631
R. 01/14
Page 3
Check here if filing a supplemental return
Mail To:Florida Department of Revenue5050 W Tennessee StTallahassee FL 32399-0165
Return Due By Late After
FEIN: (active terminal supplier)
License Number:
Collection Period Ending: (current collection period ending)
For Calendar Year
DOR USE ONLY
POSTMARK OR HAND-DELIVERY DATE
920002017999900910270318300000000100002
2017
00002
dr309631 testscript Pg. 4
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GALLONS
DIESELA. Gasoline B. Undyed C. Dyed D. Aviation
DIESEL
A. Gasoline B. Undyed C. Dyed D. Aviation
1. Beginning physical inventory: .....................................
2. Receipts: (Page 5, Section I, Line 7) ..........................
3. Disbursements: (Page 5, Section II, Line 15) ...............
4. Transfers: ....................................................................
5. Gain or (Loss): ............................................................
6. Ending physical inventory: .........................................
7. Net taxable gallons: (Page 5, Section II, Line 14,
Columns A, B, and D) .................................................
8. Tax-paid purchases: (Page 5, Section I, Line 2) .........
9. Taxable gallons: (Line 7 minus Line 8) ........................
State Tax Calculations
10. Gasoline: (Line 9, Column A times )
Diesel: (Line 9, Column B times 0000 ) ................................
11. Aviation: (Line 9, Column D times 0000 ) ....................
12. Collection allowance -
Gasoline: (Line 10, Column A times 000000 )
Aviation: (Line 11, Column D times 0000 ) ....................
13. Collection allowance -
Diesel: (Line 10, Column B times 000000 ) ..................
14. Net state fuel tax due: ................................................
Local Option - Tax and Collection
Allowance Calculations - Gasoline
15. Local option tax entitled to collection allowance -
Gasoline: (Schedule 11, Page 12, Column C total/
Schedule 5LO) ............................................................
16. Collection allowance - gasoline local option
tax: (Line 15, Column A times 0000 ) ..........................
17. Local option tax not entitled to collection allowance -
Gasoline: (Schedule 11, Page 12, Column E total/
Schedule 5LO) ............................................................
18. Total local option tax due - Gasoline: (Line 15 minus
Line 16 plus Line 17) ..................................................
Local Option - Tax and Collection Allowance – Diesel
19. Local option tax entitled to collection allowance -
Diesel: (Line 9, Column B times 0000 ) .......................
20. Collection allowance: diesel local option tax:
(Line 19, Column B times 00000 ) ...............................
21. Local option tax not entitled to collection allowance -
Diesel: (Line 9, Column B times 0000 ) .......................
22. Total local option tax due - Diesel: (Line 19 minus
Line 20 plus Line 21) ..................................................
Total State and Local Option Tax Due Calculations
23. Total tax due - Gasoline: (Line 14, Column A
plus Line 18, Column A) .............................................
24. Total tax due - Diesel: (Line 14, Column B
plus Line 22, Column B) .............................................
25. Total tax due - Aviation: (Line 14, Column D) .............
DR-309631
R. 01/14
Page 4
26. Combined gasoline, diesel, and aviation fuel tax due: (Add Lines 23, 24, and 25. Carry to Page 3, Line 26.) ................
Company Name FEIN Collection Period Ending
(mm/dd/yy)
DOLLARS
.30925.174
.069
.00326.002
.0067
.011
.07
.011
.074
132,000 2,500,000 415,0041,279,570 826,700
826,700 637,916532,438
309,5261,066,1801,126,920
1,433,820284,650
dr309631 testscript Pg.5
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1A.
2A.
2B.
3A.
3B.
11/
5LO.
5A.
5B.
5HW.
6A.
6B.
6C.
7A.
7B.
7C.
7D.
8.
10.
Section I - Receipts: (see instructions)
1. In-state refinery production: .............................
2. Gallons received - Florida tax paid: (Carry to
Page 4, Line 8.) ................................................
3. Gallons received from licensed terminal
suppliers - Florida tax unpaid (internal
exchanges): ......................................................
4. Total product received or blended -
Florida tax unpaid: ...........................................
5. Gallons imported direct to customer -
Florida tax unpaid: ...........................................
6. Gallons imported by bulk transfer into
tax-free storage: ...............................................
7. Total receipts:
(Carry to Page 4, Line 2.) ..................................
Section II - Disbursements: (see instructions)
1. Gallons delivered to retail locations and
end-users - Florida state and local
option taxes collected: .....................................
2. Gallons diesel delivered - all taxes collected
(state and local option taxes): ..........................
3. Gallons delivered - Florida state tax
collected (gasoline and aviation only): .............
4. Aviation gas converted for highway use: .........
5. Gallons delivered to licensed dealers -
Florida tax unpaid (exchanges/sales above
rack): ................................................................
6. Gallons dyed diesel delivered - Florida
tax unpaid: .......................................................
7. Gallons delivered - tax collected by supplier
from purchaser for another state: ....................
8. Gallons exported by other
than bulk transfer: ............................................
9. Gallons exported by supplier - tax self -
accrued by supplier for another state: .............
10. Gallons delivered/placed into bonded
storage - Florida tax unpaid: ............................
11. Gallons exported by supplier through
bulk transfer: ....................................................
12. Gallons delivered to U.S. Government
(500 gallons or more): .......................................
13. Gallons of undyed diesel, jet fuel, or aviation
gasoline delivered to other tax exempt entities:..
14. Total taxable disbursements: (Add Lines 1, 2,
3, 4, 8, 12, 13. Carry to Page 4, Line 7.) ..........
15. Total disbursements: (Add Lines 1 through 13.
Carry to Page 4, Line 3.) ...................................
DR-309631
R. 01/14
Page 5
GALLONS
DIESELA. Gasoline B. Undyed C. Dyed D. Aviation
From
Schedule
From
Schedule
Enter the total gallons from each receipt and disbursement schedule on this page. Report receipts and
disbursements in whole net gallons.
DIESELA. Gasoline B. Undyed C. Dyed D. Aviation
Company Name FEIN Collection Period Ending
(mm/dd/yy)
00003
770,290 112,480
509,280
826,700
419,958
532,438826,7001,279,570
111,980
1,433,820
163,527
167,000
550,000
109,700172,670
474,389
163,527
284,650 1,433,820 826,700 637,916
dr309631 testscript Pg.6
284,650 1,433,820
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Pg.
9Test
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n(5
)
Selle
r’s N
am
e
(6)
Selle
r’s F
EIN
Sub
tota
l
Sc
he
du
le T
yp
e -
On
ly o
ne
pro
du
ct
typ
e p
er
sc
he
du
le:
Pro
du
ct
Typ
e:
Sched
ule
/Pro
duct
Typ
e
Co
mp
any N
am
e
FE
IN
Co
llectio
n P
erio
d E
nd
ing
(mm
/dd
/yy)
1A
. G
allo
ns R
eceiv
ed
- F
lorid
a T
ax -
Paid
2A
. G
allo
ns R
eceiv
ed
Fro
m L
icensed
Sup
plie
r -
Flo
rid
a T
ax -
Unp
aid
(E
xchang
e)
2B
. To
tal P
rod
uct
Receiv
ed
or
Ble
nd
ed
- F
lorid
a T
ax -
Unp
aid
3A
. F
lorid
a T
ax -
Unp
aid
- G
allo
ns Im
po
rted
Direct
to C
usto
mer
3B
. G
allo
ns Im
po
rted
by B
ulk
Tra
nsfe
r In
to T
ax-f
ree S
tora
ge
065
Gaso
line
072
Dyed
Kero
sene
124
Gaso
ho
l
125
Avia
tio
n G
aso
line
130
Jet
Fuel
142
Und
yed
Kero
sene
167
Lo
w S
ulfur
Die
sel
#2/U
nd
yed
/Ble
nd
ed
Bio
die
sel (B
20,
B10, B
5, B
2)
2
26 H
igh S
ulfur
Die
sel F
uel -
Dyed
227
Lo
w S
ulfur
Die
sel F
uel -
Dyed
B
00
Und
yed
/Unb
lend
ed
Bio
die
sel (
B100)
D00
Dyed
Bio
die
sel (B
100)
E
00
Denatu
red
Eth
ano
l (g
aso
line
co
nte
nt
eq
uals
1.9
7%
to
2.4
9%
)
00004
3A / 2
26
Joes
Fue
l
Joes
Fue
l
6598
7654
3
6598
7654
3
J J
ZZ
T63A
L233
9
4589
4261
8
4589
4397
3
Hest
ers F
uel
XZY
Co
9876
5432
1
1234
5678
9
Test
5
Test
6
46,49
0
780,2
10
826,7
00dr
3096
31 te
stscr
ipt P
g. 10
Test Scrip
t
Te
rmin
al S
up
plie
r —
Sc
he
du
le o
f R
ec
eip
ts C
heck h
ere
if
filin
g a
sup
ple
menta
l sched
ule
DR
-30
96
31
R.
01
/14
Pa
ge
7
(1)
Carr
ier’s N
am
e
(2)
Carr
ier’s
FE
IN
(3)
Mode
(4)
Po
int
of
Acq
uired
Fro
m(7
)
Date
Receiv
ed
(8)
Do
cu
men
t
Nu
mb
er
(9)
Net
Gallo
ns
(10
)
Gro
ss
Gal-
lon
s
(11)
Bill
ed
Gal-
lons
Orig
inD
estinatio
n(5
)
Selle
r’s N
am
e
(6)
Selle
r’s F
EIN
Sub
tota
l
Sc
he
du
le T
yp
e -
On
ly o
ne
pro
du
ct
typ
e p
er
sc
he
du
le:
Pro
du
ct
Typ
e:
Sched
ule
/Pro
duct
Typ
e
Co
mp
any N
am
e
FE
IN
Co
llectio
n P
erio
d E
nd
ing
(mm
/dd
/yy)
1A
. G
allo
ns R
eceiv
ed
- F
lorid
a T
ax -
Paid
2A
. G
allo
ns R
eceiv
ed
Fro
m L
icensed
Sup
plie
r -
Flo
rid
a T
ax -
Unp
aid
(E
xchang
e)
2B
. To
tal P
rod
uct
Receiv
ed
or
Ble
nd
ed
- F
lorid
a T
ax -
Unp
aid
3A
. F
lorid
a T
ax -
Unp
aid
- G
allo
ns Im
po
rted
Direct
to C
usto
mer
3B
. G
allo
ns Im
po
rted
by B
ulk
Tra
nsfe
r In
to T
ax-f
ree S
tora
ge
065
Gaso
line
072
Dyed
Kero
sene
124
Gaso
ho
l
125
Avia
tio
n G
aso
line
130
Jet
Fuel
142
Und
yed
Kero
sene
167
Lo
w S
ulfur
Die
sel
#2/U
nd
yed
/Ble
nd
ed
Bio
die
sel (B
20,
B10, B
5, B
2)
2
26 H
igh S
ulfur
Die
sel F
uel -
Dyed
227
Lo
w S
ulfur
Die
sel F
uel -
Dyed
B
00
Und
yed
/Unb
lend
ed
Bio
die
sel (
B100)
D00
Dyed
Bio
die
sel (B
100)
E
00
Denatu
red
Eth
ano
l (g
aso
line
co
nte
nt
eq
uals
1.9
7%
to
2.4
9%
)
00004
We H
aul It
All
We H
aul It
All
6598
7654
3
6598
7654
3
S S
T59F
L211
6
T59F
L211
6
Supp
lier T
wo
Supp
lier T
wo
Test
15
Test
16
251,9
75
167,9
83
419,9
58
3B / 1
30
ZZ ZZ
123456789
123456789
dr30
9631
tests
cript
Pg.
11
Test Scrip
t
Te
rmin
al S
up
plie
r —
Sc
he
du
le o
f D
isb
urs
em
en
ts
Pro
du
ct
Typ
e:
DR
-30
96
31
R.
01
/14
Pa
ge
9
Sc
he
du
le T
yp
e -
On
ly o
ne
pro
du
ct
typ
e p
er
sc
he
du
le:
Use S
ch
ed
ule
11 t
o r
ep
ort
gallo
ns o
f g
aso
line d
eliv
ere
d -
all
tax c
olle
cte
d.
(1)
Carr
ier’s N
am
e
(2)
Carr
ier’s
FE
IN
(3)
Mode
(4)
Po
int
of
(5)
Term
.
Cod
e
So
ld T
o(8
)
Date
Sh
ipp
ed
(9)
Do
cu
men
t
Nu
mb
er
(10
)
Net
Gallo
ns
(11
)
Gro
ss
Gal-
lon
s
(12
)
Bill
ed
Gal-
lon
sO
rig
inD
estinatio
n(6
)
Purc
haser’s N
am
e
(7)
Purc
haser’s F
EIN
Sub
tota
l
Sched
ule
/Pro
duct
Typ
e
Co
mp
any N
am
e
FE
IN
Co
llectio
n P
erio
d E
nd
ing
(mm
/dd
/yy)
Check h
ere
if
filin
g a
sup
ple
menta
l sched
ule
5A
. G
allo
ns
Die
sel D
eliv
ere
d -
All
Taxe
s C
olle
cte
d (S
tate
an
d L
ocal)
5B
. G
allo
ns
Deliv
ere
d F
lorid
a S
tate
Tax
On
ly C
olle
cte
d (G
aso
line/A
viatio
n)
5H
W.
Avi
atio
n F
uel C
on
vert
ed
fo
r H
igh
way
Use
5L
O.
Gaso
line/G
aso
ho
l Deliv
ere
d t
o R
eta
il L
ocatio
ns
an
d E
nd
-use
rs
6A
. G
allo
ns
Deliv
ere
d t
o L
icen
sed
Deale
rs -
Flo
rid
a T
ax
- U
np
aid
(E
xch
an
ges/
Sale
s A
bo
ve R
ack)
6B
. G
allo
ns
Deliv
ere
d -
Flo
rid
a T
ax
- U
np
aid
(D
yed
Die
sel O
nly
)
6C
. G
allo
ns
Deliv
ere
d -
Tax
Co
llecte
d b
y S
up
plie
r fo
r A
no
ther
Sta
te
7A
. G
allo
ns
Exp
ort
ed
by
Oth
er
Th
an
Bu
lk T
ran
sfer
- F
lorid
a T
ax-
Paid
7B
. G
allo
ns
Exp
ort
ed
by
Su
pp
lier
- Ta
x S
elf-
accru
ed
by
Su
pp
lier
for
An
oth
er
Sta
te
7C
. G
allo
ns
Deliv
ere
d/P
laced
into
Bo
nd
ed
Sto
rag
e (A
viatio
n F
uel O
nly
)
7D
. G
allo
ns
Exp
ort
ed
By
Su
pp
lier
Th
rou
gh
Bu
lk T
ran
sfer
8.
Gallo
ns
Deliv
ere
d t
o U
.S.
Go
vern
men
t -
Tax
Exe
mp
t (5
00
Gallo
ns
or
Mo
re)
10
.G
allo
ns
of
Un
dye
d D
iese
l/Je
t F
uel D
eliv
ere
d t
o O
ther
Tax-
exe
mp
t E
ntities
065
Gaso
line
072
Dyed
Kero
sene
124
Gaso
ho
l
125
Avia
tio
n G
aso
line
130
Jet
Fuel
142
Und
yed
Kero
sene
167
Lo
w S
ulfur
Die
sel #2/U
nd
yed
/Ble
nd
ed
Bio
die
sel (B
20, B
10, B
5, B
2)
226
Hig
h S
ulfur
Die
sel F
uel -
Dyed
227
Lo
w S
ulfur
Die
sel F
uel -
Dyed
B00
Und
yed
/Unb
lend
ed
Bio
die
sel (B
100)
D00
Dyed
Bio
die
sel (B
100)
E00
Denatu
red
Eth
ano
l (g
aso
line c
onte
nt
eq
uals
1.9
7%
to
2.4
9%
)
00005
5A / 1
67
ESS
Haul
ing
6598
7654
3
6598
7654
3ES
S Ha
ulin
gJ BA
1085
0324
7
1893
0046
0
T59F
L212
2
T59F
L212
3
Quick
ie Ma
rt 5
Quick
ie Ma
rt 1
1234
5678
9987654321
Test
7
Test
8
782,1
10
651,7
10
1,433
,820
Test Scrip
t
dr30
9631
tests
cript
Pg.
12
Te
rmin
al S
up
plie
r —
Sc
he
du
le o
f D
isb
urs
em
en
ts
Pro
du
ct
Typ
e:
DR
-30
96
31
R.
01
/14
Pa
ge
9
Sc
he
du
le T
yp
e -
On
ly o
ne
pro
du
ct
typ
e p
er
sc
he
du
le:
Use S
ch
ed
ule
11 t
o r
ep
ort
gallo
ns o
f g
aso
line d
eliv
ere
d -
all
tax c
olle
cte
d.
(1)
Carr
ier’s N
am
e
(2)
Carr
ier’s
FE
IN
(3)
Mode
(4)
Po
int
of
(5)
Term
.
Cod
e
So
ld T
o(8
)
Date
Sh
ipp
ed
(9)
Do
cu
men
t
Nu
mb
er
(10
)
Net
Gallo
ns
(11
)
Gro
ss
Gal-
lon
s
(12
)
Bill
ed
Gal-
lon
sO
rig
inD
estinatio
n(6
)
Purc
haser’s N
am
e
(7)
Purc
haser’s F
EIN
Sub
tota
l
Sched
ule
/Pro
duct
Typ
e
Co
mp
any N
am
e
FE
IN
Co
llectio
n P
erio
d E
nd
ing
(mm
/dd
/yy)
Check h
ere
if
filin
g a
sup
ple
menta
l sched
ule
5A
. G
allo
ns
Die
sel D
eliv
ere
d -
All
Taxe
s C
olle
cte
d (S
tate
an
d L
ocal)
5B
. G
allo
ns
Deliv
ere
d F
lorid
a S
tate
Tax
On
ly C
olle
cte
d (G
aso
line/A
viatio
n)
5H
W.
Avi
atio
n F
uel C
on
vert
ed
fo
r H
igh
way
Use
5L
O.
Gaso
line/G
aso
ho
l Deliv
ere
d t
o R
eta
il L
ocatio
ns
an
d E
nd
-use
rs
6A
. G
allo
ns
Deliv
ere
d t
o L
icen
sed
Deale
rs -
Flo
rid
a T
ax
- U
np
aid
(E
xch
an
ges/
Sale
s A
bo
ve R
ack)
6B
. G
allo
ns
Deliv
ere
d -
Flo
rid
a T
ax
- U
np
aid
(D
yed
Die
sel O
nly
)
6C
. G
allo
ns
Deliv
ere
d -
Tax
Co
llecte
d b
y S
up
plie
r fo
r A
no
ther
Sta
te
7A
. G
allo
ns
Exp
ort
ed
by
Oth
er
Th
an
Bu
lk T
ran
sfer
- F
lorid
a T
ax-
Paid
7B
. G
allo
ns
Exp
ort
ed
by
Su
pp
lier
- Ta
x S
elf-
accru
ed
by
Su
pp
lier
for
An
oth
er
Sta
te
7C
. G
allo
ns
Deliv
ere
d/P
laced
into
Bo
nd
ed
Sto
rag
e (A
viatio
n F
uel O
nly
)
7D
. G
allo
ns
Exp
ort
ed
By
Su
pp
lier
Th
rou
gh
Bu
lk T
ran
sfer
8.
Gallo
ns
Deliv
ere
d t
o U
.S.
Go
vern
men
t -
Tax
Exe
mp
t (5
00
Gallo
ns
or
Mo
re)
10
.G
allo
ns
of
Un
dye
d D
iese
l/Je
t F
uel D
eliv
ere
d t
o O
ther
Tax-
exe
mp
t E
ntities
065
Gaso
line
072
Dyed
Kero
sene
124
Gaso
ho
l
125
Avia
tio
n G
aso
line
130
Jet
Fuel
142
Und
yed
Kero
sene
167
Lo
w S
ulfur
Die
sel #2/U
nd
yed
/Ble
nd
ed
Bio
die
sel (B
20, B
10, B
5, B
2)
226
Hig
h S
ulfur
Die
sel F
uel -
Dyed
227
Lo
w S
ulfur
Die
sel F
uel -
Dyed
B00
Und
yed
/Unb
lend
ed
Bio
die
sel (B
100)
D00
Dyed
Bio
die
sel (B
100)
E00
Denatu
red
Eth
ano
l (g
aso
line c
onte
nt
eq
uals
1.9
7%
to
2.4
9%
)
00005
5B / 1
25
Fill U
ps
6598
7654
3
Fill U
ps
6598
7654
3J J
4585
2196
1
0185
0000
2
T59F
L211
6
T59F
L211
6
Fuel
Who
lesale
r
Fuel
Who
lesale
r65
4321
987
6543
2198
7
Test
17
Test
18
98,11
7
65,41
0
163,5
27
dr30
9631
tests
cript
Pg.
13
Test Scrip
t
Te
rmin
al S
up
plie
r —
Sc
he
du
le o
f D
isb
urs
em
en
ts
Pro
du
ct
Typ
e:
DR
-30
96
31
R.
01
/14
Pa
ge
9
(1)
Carr
ier’s N
am
e
(2)
Carr
ier’s
FE
IN
(3)
Mode
(4)
Po
int
of
(5)
Term
.
Cod
e
So
ld T
o(8
)
Date
Sh
ipp
ed
(9)
Do
cu
men
t
Nu
mb
er
(10
)
Net
Gallo
ns
(11
)
Gro
ss
Gal-
lon
s
(12
)
Bill
ed
Gal-
lon
sO
rig
inD
estinatio
n(6
)
Purc
haser’s N
am
e
(7)
Purc
haser’s F
EIN
Sub
tota
l
Sched
ule
/Pro
duct
Typ
e
Co
mp
any N
am
e
FE
IN
Co
llectio
n P
erio
d E
nd
ing
(mm
/dd
/yy)
Check h
ere
if
filin
g a
sup
ple
menta
l sched
ule
5A
. G
allo
ns
Die
sel D
eliv
ere
d -
All
Taxe
s C
olle
cte
d (S
tate
an
d L
ocal)
5B
. G
allo
ns
Deliv
ere
d F
lorid
a S
tate
Tax
On
ly C
olle
cte
d (G
aso
line/A
viatio
n)
5H
W.
Avi
atio
n F
uel C
on
vert
ed
fo
r H
igh
way
Use
5L
O.
Gaso
line/G
aso
ho
l Deliv
ere
d t
o R
eta
il L
ocatio
ns
an
d E
nd
-use
rs
6A
. G
allo
ns
Deliv
ere
d t
o L
icen
sed
Deale
rs -
Flo
rid
a T
ax
- U
np
aid
(E
xch
an
ges/
Sale
s A
bo
ve R
ack)
6B
. G
allo
ns
Deliv
ere
d -
Flo
rid
a T
ax
- U
np
aid
(D
yed
Die
sel O
nly
)
6C
. G
allo
ns
Deliv
ere
d -
Tax
Co
llecte
d b
y S
up
plie
r fo
r A
no
ther
Sta
te
7A
. G
allo
ns
Exp
ort
ed
by
Oth
er
Th
an
Bu
lk T
ran
sfer
- F
lorid
a T
ax-
Paid
7B
. G
allo
ns
Exp
ort
ed
by
Su
pp
lier
- Ta
x S
elf-
accru
ed
by
Su
pp
lier
for
An
oth
er
Sta
te
7C
. G
allo
ns
Deliv
ere
d/P
laced
into
Bo
nd
ed
Sto
rag
e (A
viatio
n F
uel O
nly
)
7D
. G
allo
ns
Exp
ort
ed
By
Su
pp
lier
Th
rou
gh
Bu
lk T
ran
sfer
8.
Gallo
ns
Deliv
ere
d t
o U
.S.
Go
vern
men
t -
Tax
Exe
mp
t (5
00
Gallo
ns
or
Mo
re)
10
.G
allo
ns
of
Un
dye
d D
iese
l/Je
t F
uel D
eliv
ere
d t
o O
ther
Tax-
exe
mp
t E
ntities
065
Gaso
line
072
Dyed
Kero
sene
124
Gaso
ho
l
125
Avia
tio
n G
aso
line
130
Jet
Fuel
142
Und
yed
Kero
sene
167
Lo
w S
ulfur
Die
sel #2/U
nd
yed
/Ble
nd
ed
Bio
die
sel (B
20, B
10, B
5, B
2)
226
Hig
h S
ulfur
Die
sel F
uel -
Dyed
227
Lo
w S
ulfur
Die
sel F
uel -
Dyed
B00
Und
yed
/Unb
lend
ed
Bio
die
sel (B
100)
D00
Dyed
Bio
die
sel (B
100)
E00
Denatu
red
Eth
ano
l (g
aso
line c
onte
nt
eq
uals
1.9
7%
to
2.4
9%
)
00005
RST
Carri
ers
RST
Carri
ers
6598
7654
3
6598
7654
3
J J
ZZ ZZ
1211
1111
1
0988
4236
7
Bobs
Gas
Mar
t
Bobs
Gas
Mar
t
1234
5678
9
1234
5678
9
Test
9Te
st 10
45,79
0
66,19
0
111,9
80
5LO
/ 065
dr30
9631
tests
cript
Pg.
14
Test Scrip
t
Te
rmin
al S
up
plie
r —
Sc
he
du
le o
f D
isb
urs
em
en
ts
Pro
du
ct
Typ
e:
DR
-30
96
31
R.
01
/14
Pa
ge
9
Sc
he
du
le T
yp
e -
On
ly o
ne
pro
du
ct
typ
e p
er
sc
he
du
le:
Use S
ch
ed
ule
11 t
o r
ep
ort
gallo
ns o
f g
aso
line d
eliv
ere
d -
all
tax c
olle
cte
d.
(1)
Carr
ier’s N
am
e
(2)
Carr
ier’s
FE
IN
(3)
Mode
(4)
Po
int
of
(5)
Term
.
Cod
e
So
ld T
o(8
)
Date
Sh
ipp
ed
(9)
Do
cu
men
t
Nu
mb
er
(10
)
Net
Gallo
ns
(11
)
Gro
ss
Gal-
lon
s
(12
)
Bill
ed
Gal-
lon
sO
rig
inD
estinatio
n(6
)
Purc
haser’s N
am
e
(7)
Purc
haser’s F
EIN
Sub
tota
l
Sched
ule
/Pro
duct
Typ
e
Co
mp
any N
am
e
FE
IN
Co
llectio
n P
erio
d E
nd
ing
(mm
/dd
/yy)
Check h
ere
if
filin
g a
sup
ple
menta
l sched
ule
5A
. G
allo
ns
Die
sel D
eliv
ere
d -
All
Taxe
s C
olle
cte
d (S
tate
an
d L
ocal)
5B
. G
allo
ns
Deliv
ere
d F
lorid
a S
tate
Tax
On
ly C
olle
cte
d (G
aso
line/A
viatio
n)
5H
W.
Avi
atio
n F
uel C
on
vert
ed
fo
r H
igh
way
Use
5L
O.
Gaso
line/G
aso
ho
l Deliv
ere
d t
o R
eta
il L
ocatio
ns
an
d E
nd
-use
rs
6A
. G
allo
ns
Deliv
ere
d t
o L
icen
sed
Deale
rs -
Flo
rid
a T
ax
- U
np
aid
(E
xch
an
ges/
Sale
s A
bo
ve R
ack)
6B
. G
allo
ns
Deliv
ere
d -
Flo
rid
a T
ax
- U
np
aid
(D
yed
Die
sel O
nly
)
6C
. G
allo
ns
Deliv
ere
d -
Tax
Co
llecte
d b
y S
up
plie
r fo
r A
no
ther
Sta
te
7A
. G
allo
ns
Exp
ort
ed
by
Oth
er
Th
an
Bu
lk T
ran
sfer
- F
lorid
a T
ax-
Paid
7B
. G
allo
ns
Exp
ort
ed
by
Su
pp
lier
- Ta
x S
elf-
accru
ed
by
Su
pp
lier
for
An
oth
er
Sta
te
7C
. G
allo
ns
Deliv
ere
d/P
laced
into
Bo
nd
ed
Sto
rag
e (A
viatio
n F
uel O
nly
)
7D
. G
allo
ns
Exp
ort
ed
By
Su
pp
lier
Th
rou
gh
Bu
lk T
ran
sfer
8.
Gallo
ns
Deliv
ere
d t
o U
.S.
Go
vern
men
t -
Tax
Exe
mp
t (5
00
Gallo
ns
or
Mo
re)
10
.G
allo
ns
of
Un
dye
d D
iese
l/Je
t F
uel D
eliv
ere
d t
o O
ther
Tax-
exe
mp
t E
ntities
065
Gaso
line
072
Dyed
Kero
sene
124
Gaso
ho
l
125
Avia
tio
n G
aso
line
130
Jet
Fuel
142
Und
yed
Kero
sene
167
Lo
w S
ulfur
Die
sel #2/U
nd
yed
/Ble
nd
ed
Bio
die
sel (B
20, B
10, B
5, B
2)
226
Hig
h S
ulfur
Die
sel F
uel -
Dyed
227
Lo
w S
ulfur
Die
sel F
uel -
Dyed
B00
Und
yed
/Unb
lend
ed
Bio
die
sel (B
100)
D00
Dyed
Bio
die
sel (B
100)
E00
Denatu
red
Eth
ano
l (g
aso
line c
onte
nt
eq
uals
1.9
7%
to
2.4
9%
)
00005
6A / 2
27
Fill U
ps
6598
7654
3
Fill U
ps
6598
7654
3
ST ST
T59F
L211
6
T59F
L211
6
Off R
oad
Dies
el65
9876
543
6598
7654
3
Test
19
Test
20
100,2
00
66,80
0
167,0
00
T59F
L211
6
T59F
L211
6Of
f Roa
d Di
esel
dr30
9631
tests
cript
Pg.
15
Test Scrip
t
Te
rmin
al S
up
plie
r —
Sc
he
du
le o
f D
isb
urs
em
en
ts
Pro
du
ct
Typ
e:
DR
-30
96
31
R.
01
/14
Pa
ge
9
Sc
he
du
le T
yp
e -
On
ly o
ne
pro
du
ct
typ
e p
er
sc
he
du
le:
Use S
ch
ed
ule
11 t
o r
ep
ort
gallo
ns o
f g
aso
line d
eliv
ere
d -
all
tax c
olle
cte
d.
(1)
Carr
ier’s N
am
e
(2)
Carr
ier’s
FE
IN
(3)
Mode
(4)
Po
int
of
(5)
Term
.
Cod
e
So
ld T
o(8
)
Date
Sh
ipp
ed
(9)
Do
cu
men
t
Nu
mb
er
(10
)
Net
Gallo
ns
(11
)
Gro
ss
Gal-
lon
s
(12
)
Bill
ed
Gal-
lon
sO
rig
inD
estinatio
n(6
)
Purc
haser’s N
am
e
(7)
Purc
haser’s F
EIN
Sub
tota
l
Sched
ule
/Pro
duct
Typ
e
Co
mp
any N
am
e
FE
IN
Co
llectio
n P
erio
d E
nd
ing
(mm
/dd
/yy)
Check h
ere
if
filin
g a
sup
ple
menta
l sched
ule
5A
. G
allo
ns
Die
sel D
eliv
ere
d -
All
Taxe
s C
olle
cte
d (S
tate
an
d L
ocal)
5B
. G
allo
ns
Deliv
ere
d F
lorid
a S
tate
Tax
On
ly C
olle
cte
d (G
aso
line/A
viatio
n)
5H
W.
Avi
atio
n F
uel C
on
vert
ed
fo
r H
igh
way
Use
5L
O.
Gaso
line/G
aso
ho
l Deliv
ere
d t
o R
eta
il L
ocatio
ns
an
d E
nd
-use
rs
6A
. G
allo
ns
Deliv
ere
d t
o L
icen
sed
Deale
rs -
Flo
rid
a T
ax
- U
np
aid
(E
xch
an
ges/
Sale
s A
bo
ve R
ack)
6B
. G
allo
ns
Deliv
ere
d -
Flo
rid
a T
ax
- U
np
aid
(D
yed
Die
sel O
nly
)
6C
. G
allo
ns
Deliv
ere
d -
Tax
Co
llecte
d b
y S
up
plie
r fo
r A
no
ther
Sta
te
7A
. G
allo
ns
Exp
ort
ed
by
Oth
er
Th
an
Bu
lk T
ran
sfer
- F
lorid
a T
ax-
Paid
7B
. G
allo
ns
Exp
ort
ed
by
Su
pp
lier
- Ta
x S
elf-
accru
ed
by
Su
pp
lier
for
An
oth
er
Sta
te
7C
. G
allo
ns
Deliv
ere
d/P
laced
into
Bo
nd
ed
Sto
rag
e (A
viatio
n F
uel O
nly
)
7D
. G
allo
ns
Exp
ort
ed
By
Su
pp
lier
Th
rou
gh
Bu
lk T
ran
sfer
8.
Gallo
ns
Deliv
ere
d t
o U
.S.
Go
vern
men
t -
Tax
Exe
mp
t (5
00
Gallo
ns
or
Mo
re)
10
.G
allo
ns
of
Un
dye
d D
iese
l/Je
t F
uel D
eliv
ere
d t
o O
ther
Tax-
exe
mp
t E
ntities
065
Gaso
line
072
Dyed
Kero
sene
124
Gaso
ho
l
125
Avia
tio
n G
aso
line
130
Jet
Fuel
142
Und
yed
Kero
sene
167
Lo
w S
ulfur
Die
sel #2/U
nd
yed
/Ble
nd
ed
Bio
die
sel (B
20, B
10, B
5, B
2)
226
Hig
h S
ulfur
Die
sel F
uel -
Dyed
227
Lo
w S
ulfur
Die
sel F
uel -
Dyed
B00
Und
yed
/Unb
lend
ed
Bio
die
sel (B
100)
D00
Dyed
Bio
die
sel (B
100)
E00
Denatu
red
Eth
ano
l (g
aso
line c
onte
nt
eq
uals
1.9
7%
to
2.4
9%
)
00005
6B / 2
27
Fill U
ps
6598
7654
3
Fill U
ps
6598
7654
3
J J
T59F
L211
6
T59F
L211
6
Dyed
Sta
tion
Inc
147
8523
69
1478
5236
9
Test
21
Test
22
330,0
00
220,0
00
FL
FLDy
ed S
tatio
n In
c
550
,000
dr30
9631
tests
cript
Pg.
16
Test Scrip
t
Te
rmin
al S
up
plie
r —
Sc
he
du
le o
f D
isb
urs
em
en
ts
Pro
du
ct
Typ
e:
DR
-30
96
31
R.
01
/14
Pa
ge
9
Sc
he
du
le T
yp
e -
On
ly o
ne
pro
du
ct
typ
e p
er
sc
he
du
le:
Use S
ch
ed
ule
11 t
o r
ep
ort
gallo
ns o
f g
aso
line d
eliv
ere
d -
all
tax c
olle
cte
d.
(1)
Carr
ier’s N
am
e
(2)
Carr
ier’s
FE
IN
(3)
Mode
(4)
Po
int
of
(5)
Term
.
Cod
e
So
ld T
o(8
)
Date
Sh
ipp
ed
(9)
Do
cu
men
t
Nu
mb
er
(10
)
Net
Gallo
ns
(11
)
Gro
ss
Gal-
lon
s
(12
)
Bill
ed
Gal-
lon
sO
rig
inD
estinatio
n(6
)
Purc
haser’s N
am
e
(7)
Purc
haser’s F
EIN
Sub
tota
l
Sched
ule
/Pro
duct
Typ
e
Co
mp
any N
am
e
FE
IN
Co
llectio
n P
erio
d E
nd
ing
(mm
/dd
/yy)
Check h
ere
if
filin
g a
sup
ple
menta
l sched
ule
5A
. G
allo
ns
Die
sel D
eliv
ere
d -
All
Taxe
s C
olle
cte
d (S
tate
an
d L
ocal)
5B
. G
allo
ns
Deliv
ere
d F
lorid
a S
tate
Tax
On
ly C
olle
cte
d (G
aso
line/A
viatio
n)
5H
W.
Avi
atio
n F
uel C
on
vert
ed
fo
r H
igh
way
Use
5L
O.
Gaso
line/G
aso
ho
l Deliv
ere
d t
o R
eta
il L
ocatio
ns
an
d E
nd
-use
rs
6A
. G
allo
ns
Deliv
ere
d t
o L
icen
sed
Deale
rs -
Flo
rid
a T
ax
- U
np
aid
(E
xch
an
ges/
Sale
s A
bo
ve R
ack)
6B
. G
allo
ns
Deliv
ere
d -
Flo
rid
a T
ax
- U
np
aid
(D
yed
Die
sel O
nly
)
6C
. G
allo
ns
Deliv
ere
d -
Tax
Co
llecte
d b
y S
up
plie
r fo
r A
no
ther
Sta
te
7A
. G
allo
ns
Exp
ort
ed
by
Oth
er
Th
an
Bu
lk T
ran
sfer
- F
lorid
a T
ax-
Paid
7B
. G
allo
ns
Exp
ort
ed
by
Su
pp
lier
- Ta
x S
elf-
accru
ed
by
Su
pp
lier
for
An
oth
er
Sta
te
7C
. G
allo
ns
Deliv
ere
d/P
laced
into
Bo
nd
ed
Sto
rag
e (A
viatio
n F
uel O
nly
)
7D
. G
allo
ns
Exp
ort
ed
By
Su
pp
lier
Th
rou
gh
Bu
lk T
ran
sfer
8.
Gallo
ns
Deliv
ere
d t
o U
.S.
Go
vern
men
t -
Tax
Exe
mp
t (5
00
Gallo
ns
or
Mo
re)
10
.G
allo
ns
of
Un
dye
d D
iese
l/Je
t F
uel D
eliv
ere
d t
o O
ther
Tax-
exe
mp
t E
ntities
065
Gaso
line
072
Dyed
Kero
sene
124
Gaso
ho
l
125
Avia
tio
n G
aso
line
130
Jet
Fuel
142
Und
yed
Kero
sene
167
Lo
w S
ulfur
Die
sel #2/U
nd
yed
/Ble
nd
ed
Bio
die
sel (B
20, B
10, B
5, B
2)
226
Hig
h S
ulfur
Die
sel F
uel -
Dyed
227
Lo
w S
ulfur
Die
sel F
uel -
Dyed
B00
Und
yed
/Unb
lend
ed
Bio
die
sel (B
100)
D00
Dyed
Bio
die
sel (B
100)
E00
Denatu
red
Eth
ano
l (g
aso
line c
onte
nt
eq
uals
1.9
7%
to
2.4
9%
)
00005
7A / 2
27
Fill U
ps
6598
7654
3
Fill U
ps
6598
7654
3
J J
T59F
L211
6
T59F
L211
6
Fuel
Who
lesale
r
7539
5185
2
7539
5185
2
Test
23
Test
24
65,82
0
43,88
0
GA
GAFu
el W
holes
aler
109,7
00
dr30
9631
tests
cript
Pg.
17
Test Scrip
t
Te
rmin
al S
up
plie
r —
Sc
he
du
le o
f D
isb
urs
em
en
ts
Pro
du
ct
Typ
e:
DR
-30
96
31
R.
01
/14
Pa
ge
9
Sc
he
du
le T
yp
e -
On
ly o
ne
pro
du
ct
typ
e p
er
sc
he
du
le:
Use S
ch
ed
ule
11 t
o r
ep
ort
gallo
ns o
f g
aso
line d
eliv
ere
d -
all
tax c
olle
cte
d.
(1)
Carr
ier’s N
am
e
(2)
Carr
ier’s
FE
IN
(3)
Mode
(4)
Po
int
of
(5)
Term
.
Cod
e
So
ld T
o(8
)
Date
Sh
ipp
ed
(9)
Do
cu
men
t
Nu
mb
er
(10
)
Net
Gallo
ns
(11
)
Gro
ss
Gal-
lon
s
(12
)
Bill
ed
Gal-
lon
sO
rig
inD
estinatio
n(6
)
Purc
haser’s N
am
e
(7)
Purc
haser’s F
EIN
Sub
tota
l
Sched
ule
/Pro
duct
Typ
e
Co
mp
any N
am
e
FE
IN
Co
llectio
n P
erio
d E
nd
ing
(mm
/dd
/yy)
Check h
ere
if
filin
g a
sup
ple
menta
l sched
ule
5A
. G
allo
ns
Die
sel D
eliv
ere
d -
All
Taxe
s C
olle
cte
d (S
tate
an
d L
ocal)
5B
. G
allo
ns
Deliv
ere
d F
lorid
a S
tate
Tax
On
ly C
olle
cte
d (G
aso
line/A
viatio
n)
5H
W.
Avi
atio
n F
uel C
on
vert
ed
fo
r H
igh
way
Use
5L
O.
Gaso
line/G
aso
ho
l Deliv
ere
d t
o R
eta
il L
ocatio
ns
an
d E
nd
-use
rs
6A
. G
allo
ns
Deliv
ere
d t
o L
icen
sed
Deale
rs -
Flo
rid
a T
ax
- U
np
aid
(E
xch
an
ges/
Sale
s A
bo
ve R
ack)
6B
. G
allo
ns
Deliv
ere
d -
Flo
rid
a T
ax
- U
np
aid
(D
yed
Die
sel O
nly
)
6C
. G
allo
ns
Deliv
ere
d -
Tax
Co
llecte
d b
y S
up
plie
r fo
r A
no
ther
Sta
te
7A
. G
allo
ns
Exp
ort
ed
by
Oth
er
Th
an
Bu
lk T
ran
sfer
- F
lorid
a T
ax-
Paid
7B
. G
allo
ns
Exp
ort
ed
by
Su
pp
lier
- Ta
x S
elf-
accru
ed
by
Su
pp
lier
for
An
oth
er
Sta
te
7C
. G
allo
ns
Deliv
ere
d/P
laced
into
Bo
nd
ed
Sto
rag
e (A
viatio
n F
uel O
nly
)
7D
. G
allo
ns
Exp
ort
ed
By
Su
pp
lier
Th
rou
gh
Bu
lk T
ran
sfer
8.
Gallo
ns
Deliv
ere
d t
o U
.S.
Go
vern
men
t -
Tax
Exe
mp
t (5
00
Gallo
ns
or
Mo
re)
10
.G
allo
ns
of
Un
dye
d D
iese
l/Je
t F
uel D
eliv
ere
d t
o O
ther
Tax-
exe
mp
t E
ntities
065
Gaso
line
072
Dyed
Kero
sene
124
Gaso
ho
l
125
Avia
tio
n G
aso
line
130
Jet
Fuel
142
Und
yed
Kero
sene
167
Lo
w S
ulfur
Die
sel #2/U
nd
yed
/Ble
nd
ed
Bio
die
sel (B
20, B
10, B
5, B
2)
226
Hig
h S
ulfur
Die
sel F
uel -
Dyed
227
Lo
w S
ulfur
Die
sel F
uel -
Dyed
B00
Und
yed
/Unb
lend
ed
Bio
die
sel (B
100)
D00
Dyed
Bio
die
sel (B
100)
E00
Denatu
red
Eth
ano
l (g
aso
line c
onte
nt
eq
uals
1.9
7%
to
2.4
9%
)
00005
7A / E
00
Gas I
s Us
Gas I
s Us
6598
7654
3
6598
7654
3
J J
T65F
L216
5
T65F
L216
5
GA GA
Mick
eys
Mick
eys
1234
5678
9
1234
5678
9
Test
11
Test
12
94,25
0
78,42
0
172,6
70
dr30
9631
tests
cript
Pg.
18
Test Scrip
t
Te
rmin
al S
up
plie
r —
Sc
he
du
le o
f D
isb
urs
em
en
ts
Pro
du
ct
Typ
e:
DR
-30
96
31
R.
01
/14
Pa
ge
9
Sc
he
du
le T
yp
e -
On
ly o
ne
pro
du
ct
typ
e p
er
sc
he
du
le:
Use S
ch
ed
ule
11 t
o r
ep
ort
gallo
ns o
f g
aso
line d
eliv
ere
d -
all
tax c
olle
cte
d.
(1)
Carr
ier’s N
am
e
(2)
Carr
ier’s
FE
IN
(3)
Mode
(4)
Po
int
of
(5)
Term
.
Cod
e
So
ld T
o(8
)
Date
Sh
ipp
ed
(9)
Do
cu
men
t
Nu
mb
er
(10
)
Net
Gallo
ns
(11
)
Gro
ss
Gal-
lon
s
(12
)
Bill
ed
Gal-
lon
sO
rig
inD
estinatio
n(6
)
Purc
haser’s N
am
e
(7)
Purc
haser’s F
EIN
Sub
tota
l
Sched
ule
/Pro
duct
Typ
e
Co
mp
any N
am
e
FE
IN
Co
llectio
n P
erio
d E
nd
ing
(mm
/dd
/yy)
Check h
ere
if
filin
g a
sup
ple
menta
l sched
ule
5A
. G
allo
ns
Die
sel D
eliv
ere
d -
All
Taxe
s C
olle
cte
d (S
tate
an
d L
ocal)
5B
. G
allo
ns
Deliv
ere
d F
lorid
a S
tate
Tax
On
ly C
olle
cte
d (G
aso
line/A
viatio
n)
5H
W.
Avi
atio
n F
uel C
on
vert
ed
fo
r H
igh
way
Use
5L
O.
Gaso
line/G
aso
ho
l Deliv
ere
d t
o R
eta
il L
ocatio
ns
an
d E
nd
-use
rs
6A
. G
allo
ns
Deliv
ere
d t
o L
icen
sed
Deale
rs -
Flo
rid
a T
ax
- U
np
aid
(E
xch
an
ges/
Sale
s A
bo
ve R
ack)
6B
. G
allo
ns
Deliv
ere
d -
Flo
rid
a T
ax
- U
np
aid
(D
yed
Die
sel O
nly
)
6C
. G
allo
ns
Deliv
ere
d -
Tax
Co
llecte
d b
y S
up
plie
r fo
r A
no
ther
Sta
te
7A
. G
allo
ns
Exp
ort
ed
by
Oth
er
Th
an
Bu
lk T
ran
sfer
- F
lorid
a T
ax-
Paid
7B
. G
allo
ns
Exp
ort
ed
by
Su
pp
lier
- Ta
x S
elf-
accru
ed
by
Su
pp
lier
for
An
oth
er
Sta
te
7C
. G
allo
ns
Deliv
ere
d/P
laced
into
Bo
nd
ed
Sto
rag
e (A
viatio
n F
uel O
nly
)
7D
. G
allo
ns
Exp
ort
ed
By
Su
pp
lier
Th
rou
gh
Bu
lk T
ran
sfer
8.
Gallo
ns
Deliv
ere
d t
o U
.S.
Go
vern
men
t -
Tax
Exe
mp
t (5
00
Gallo
ns
or
Mo
re)
10
.G
allo
ns
of
Un
dye
d D
iese
l/Je
t F
uel D
eliv
ere
d t
o O
ther
Tax-
exe
mp
t E
ntities
065
Gaso
line
072
Dyed
Kero
sene
124
Gaso
ho
l
125
Avia
tio
n G
aso
line
130
Jet
Fuel
142
Und
yed
Kero
sene
167
Lo
w S
ulfur
Die
sel #2/U
nd
yed
/Ble
nd
ed
Bio
die
sel (B
20, B
10, B
5, B
2)
226
Hig
h S
ulfur
Die
sel F
uel -
Dyed
227
Lo
w S
ulfur
Die
sel F
uel -
Dyed
B00
Und
yed
/Unb
lend
ed
Bio
die
sel (B
100)
D00
Dyed
Bio
die
sel (B
100)
E00
Denatu
red
Eth
ano
l (g
aso
line c
onte
nt
eq
uals
1.9
7%
to
2.4
9%
)
00005
7C / 1
30
Fill U
ps
6598
7654
3
Fill U
ps
6598
7654
3
PL PL
T59F
L211
6
T59F
L211
6
Fore
ign
Trad
e Zon
e 1
4785
2369
7418
5296
3
Test
25
Test
26
284,6
34
189,7
55
FL
FLFo
reig
n Tr
ade Z
one
474,3
89
dr30
9631
tests
cript
Pg.
19
Test Scrip
t
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): If zero, skip to Line 24 ........
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
zero 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) ..................
Schedule 12 — Ultimate vendor credits worksheet for reporting deliveries and exports of tax paid fuel
to consumers who qualify to purchase fuel tax-exempt
GALLONS
DIESEL
A. Gasoline B. Undyed C. Dyed D. Aviation
25. Total ultimate vendor credit amount: (Add Line 24A, Line 24B, and Line 24C. Carry forward to Page 3, Line 27.) . .......
DR-309631
R. 01/14
Page 13
Check here if filing a supplemental schedule
12/
Schedule Company Name FEIN Collection Period Ending
(mm/dd/yy)
.30925 .174 .069
.00326 .0067 .002
.07
.011
.074
.30925 .174 .069
.00163 .00335 .001
00007
172,670
172,670
dr309631 testscript Pg. 20
Test Scrip
t
