Form R-5376 "Interstate Motor Fuel User Quarterly Tax Return Schedules a and B - Detail of Miles Traveled and Diesel Fuels Consumed and Louisiana Purchases of Taxpaid Diesel Fuels" - Louisiana

Form R-5376 or the "Interstate Motor Fuel User Quarterly Tax Return Schedules A And B - Detail Of Miles Traveled And Diesel Fuels Consumed And Louisiana Purchases Of Taxpaid Diesel Fuels" is a form issued by the Louisiana Department of Revenue.

The form was last revised in July 1, 2006 and is available for digital filing. Download an up-to-date Form R-5376 in PDF-format down below or look it up on the Louisiana Department of Revenue Forms website.

ADVERTISEMENT

Download Form R-5376 "Interstate Motor Fuel User Quarterly Tax Return Schedules a and B - Detail of Miles Traveled and Diesel Fuels Consumed and Louisiana Purchases of Taxpaid Diesel Fuels" - Louisiana

502 times
Rate
(4.6 / 5) 25 votes
R-5376 (7/06)
Interstate Motor Fuel User
Quarterly Tax Return
Schedule A
Detail of Miles Traveled and
Diesel Fuels Consumed
Company Name
FEIN
LA Revenue Account Number
Filing Period
NOTE: To be completed and submitted with Interstate Motor Fuel User Quarterly Tax Return. See instructions on reverse side of the return form R-5375.
Column 1
Column 2
Column 3
Column 4
Name of State
Miles Traveled
Gallons Consumed
Gallons Put in Vehicles
Louisiana
OTHER STATES
(list by state)
Total Operations in All States
7675
R-5376 (7/06)
Interstate Motor Fuel User
Quarterly Tax Return
Schedule A
Detail of Miles Traveled and
Diesel Fuels Consumed
Company Name
FEIN
LA Revenue Account Number
Filing Period
NOTE: To be completed and submitted with Interstate Motor Fuel User Quarterly Tax Return. See instructions on reverse side of the return form R-5375.
Column 1
Column 2
Column 3
Column 4
Name of State
Miles Traveled
Gallons Consumed
Gallons Put in Vehicles
Louisiana
OTHER STATES
(list by state)
Total Operations in All States
7675
R-5376 (7/06)
Interstate Motor Fuel User
Quarterly Tax Return
Schedule B
Louisiana Purchases of
Taxpaid Diesel Fuels
Company Name
FEIN
LA Revenue Account Number
Filing Period
Section 1 Bulk Purchases From Distributors
(attach copies of invoices)
Date
Invoice Number
Purchased From
Address
Gallons
Total – enter here and on Line (b) of Section 3 below
Section 2 Service Station Purchases
(attach original invoices if applying for refund)
Date
Invoice Number
Purchased From
Address
Gallons
Total – enter here and add to Line (d), Section 3 below
Section 3 Louisiana Taxpaid Storage
a. Beginning Inventory (closing inventory from previous quarter)
b. Bulk purchases (total from Section 1)
c. Closing inventory
d. Total gallons of fuel withdrawn from storage (Line a plus Line b minus Line c)
Section 4. Total Gallons Placed in Vehicles in Louisiana
Section 2 total plus Line d, Section 3. Enter here and on Line 6 of return, R-5375
7676
ADVERTISEMENT
Page of 2