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

What Is Form R-5376?

This is a legal form that was released by the Louisiana Department of Revenue - a government authority operating within Louisiana. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on July 1, 2006;
  • The latest edition provided by the Louisiana Department of Revenue;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form R-5376 by clicking the link below or browse more documents and templates provided by the Louisiana Department of Revenue.

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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

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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
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