Form GA-1-D "Motor Fuel Distributors Report" - New Jersey

What Is Form GA-1-D?

This is a legal form that was released by the New Jersey Department of the Treasury - a government authority operating within New Jersey. Check the official instructions before completing and submitting the form.

Form Details:

  • Released on May 1, 2004;
  • The latest edition provided by the New Jersey Department of the Treasury;
  • 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 GA-1-D by clicking the link below or browse more documents and templates provided by the New Jersey Department of the Treasury.

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Download Form GA-1-D "Motor Fuel Distributors Report" - New Jersey

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GA-1-D
State of New Jersey
05-04, R-13
MOTOR FUEL DISTRIBUTORS REPORT
For the Month of
Year:
SUBMIT FORM IN DUPLICATE
THIS FORM TO BE USED BY LICENSED NJ GASOLINE DISTRIBUTORS
THIS FORM MAY BE REPRODUCED
License Number
Federal Identification Number
Tax remittance due with report:
Make check payable to “State of New Jersey – “MFT” and mail
with report to:
Division of Taxation
Revenue Processing Center
PO Box 243, Trenton NJ 08646-0243
th
Licensee Name
Due Date: Must be received on or before the 20
of the month
following the report month.
All gallon figures are to round to the nearest gallon.
Mailing Address
Please show all figures as positives (No negatives).
Inventories & Receipts
Gallons
Distribution
Gallons
Opening Inventory – Gasoline
Gasoline Sold Delivered Tax Collected
1
10
(Including gallons in transit)
(attach Sch. 6 if delivered to licensees)
Gasoline Sold Delivered to Licensed
Gasoline Received Tax Paid
2
11
Distributors & Jobbers
(attach Schedule 1)
Tax Not Collected (attach Schedule 7)
Gasoline Received from License
Gasoline Exported to Other States
3
12
Holder Tax Unpaid (attach Schedule 2)
(Attach Schedule 8)
Gasoline Imported from Another State
Gasoline Delivered to Government
4
13
Delivered Direct to Customers
Agencies Tax Exempt
(Attach Schedule 3)
(Attach Schedule 9)
Gasoline Imported from Another State
Other Non-taxable Distribution
5
14
Delivered into Tax Free Storage
(Attach Schedule 10)
(Attach Schedule 4)
Gain or Loss
G
L
6
Other Receipts (Schedule 5)
15
(Check One)
Total Gallons Handled
Gallons Accounted for:
7
16
(Add Lines 1 through 6)
(Total Lines 10 through 15)
Less: Closing Inventory
8
(Including gallons in transit)
Gallons to be Accounted for:
9
(Subtract Line 8 from Line 7)
(A) Gasoline
(B)
Tax Computation
Amount (A) X .105
Gallons at 10.5¢
17
Total Taxable Distribution at Appropriate Rate Per Gallon
18
Less Tax Paid Purchases (Schedule 1)
19
Less Dealer Sales to Governmental Agencies (Form 6060 Attached) (Schedule 9)
20
Less Refundable Uses
21
Total (Line 17 Less Lines 18, 19 and 20)
22
Add Adjustment of Previous Month’s Report (Schedule GA-1C)
23
Less Adjustment of Previous Month’s Report (Schedule GA-1C)
24
Total Tax – Gasoline (Line 21 plus Line 22 minus 23)
25
ADD: Airport Safety Tax (From Schedule GA-IV)
26
ADD: Penalty and Interest
27
Less: Total Credit from Previous Month
28
Less: Total Amount Paid with Estimated Return or by Electronic Funds Transfer
BALANCE DUE: (If Total of Lines 24, 25, and 26 is GREATER than total of Lines 27 and 28) Enter
29
Amount Here.
OVERPAYMENT: (If the Total of Lines 24, 25, and 26 is LESS than total of Lines 27 and 28)
30
Pay this
AMOUNT TO BE CREDITED
Amount
SIGNATURE AND VERIFICATION
I declare under the penalties provided by law, that this return (including any accompanying schedules and statements) have been examined by me and to the best of my
knowledge and belief is a true, correct and complete return. If the return is prepared by a person other than the taxpayer, his declaration is based on all the information relating to
the matters required to be reported in the return of which he has knowledge.
(Date)
(Signature of Duly Authorized Officer of Taxpayer)
(Title)
(Date)
(Signature of Individual Preparing Return)
(Address)
(Phone#)
(Preparers ID#)
GA-1-D
State of New Jersey
05-04, R-13
MOTOR FUEL DISTRIBUTORS REPORT
For the Month of
Year:
SUBMIT FORM IN DUPLICATE
THIS FORM TO BE USED BY LICENSED NJ GASOLINE DISTRIBUTORS
THIS FORM MAY BE REPRODUCED
License Number
Federal Identification Number
Tax remittance due with report:
Make check payable to “State of New Jersey – “MFT” and mail
with report to:
Division of Taxation
Revenue Processing Center
PO Box 243, Trenton NJ 08646-0243
th
Licensee Name
Due Date: Must be received on or before the 20
of the month
following the report month.
All gallon figures are to round to the nearest gallon.
Mailing Address
Please show all figures as positives (No negatives).
Inventories & Receipts
Gallons
Distribution
Gallons
Opening Inventory – Gasoline
Gasoline Sold Delivered Tax Collected
1
10
(Including gallons in transit)
(attach Sch. 6 if delivered to licensees)
Gasoline Sold Delivered to Licensed
Gasoline Received Tax Paid
2
11
Distributors & Jobbers
(attach Schedule 1)
Tax Not Collected (attach Schedule 7)
Gasoline Received from License
Gasoline Exported to Other States
3
12
Holder Tax Unpaid (attach Schedule 2)
(Attach Schedule 8)
Gasoline Imported from Another State
Gasoline Delivered to Government
4
13
Delivered Direct to Customers
Agencies Tax Exempt
(Attach Schedule 3)
(Attach Schedule 9)
Gasoline Imported from Another State
Other Non-taxable Distribution
5
14
Delivered into Tax Free Storage
(Attach Schedule 10)
(Attach Schedule 4)
Gain or Loss
G
L
6
Other Receipts (Schedule 5)
15
(Check One)
Total Gallons Handled
Gallons Accounted for:
7
16
(Add Lines 1 through 6)
(Total Lines 10 through 15)
Less: Closing Inventory
8
(Including gallons in transit)
Gallons to be Accounted for:
9
(Subtract Line 8 from Line 7)
(A) Gasoline
(B)
Tax Computation
Amount (A) X .105
Gallons at 10.5¢
17
Total Taxable Distribution at Appropriate Rate Per Gallon
18
Less Tax Paid Purchases (Schedule 1)
19
Less Dealer Sales to Governmental Agencies (Form 6060 Attached) (Schedule 9)
20
Less Refundable Uses
21
Total (Line 17 Less Lines 18, 19 and 20)
22
Add Adjustment of Previous Month’s Report (Schedule GA-1C)
23
Less Adjustment of Previous Month’s Report (Schedule GA-1C)
24
Total Tax – Gasoline (Line 21 plus Line 22 minus 23)
25
ADD: Airport Safety Tax (From Schedule GA-IV)
26
ADD: Penalty and Interest
27
Less: Total Credit from Previous Month
28
Less: Total Amount Paid with Estimated Return or by Electronic Funds Transfer
BALANCE DUE: (If Total of Lines 24, 25, and 26 is GREATER than total of Lines 27 and 28) Enter
29
Amount Here.
OVERPAYMENT: (If the Total of Lines 24, 25, and 26 is LESS than total of Lines 27 and 28)
30
Pay this
AMOUNT TO BE CREDITED
Amount
SIGNATURE AND VERIFICATION
I declare under the penalties provided by law, that this return (including any accompanying schedules and statements) have been examined by me and to the best of my
knowledge and belief is a true, correct and complete return. If the return is prepared by a person other than the taxpayer, his declaration is based on all the information relating to
the matters required to be reported in the return of which he has knowledge.
(Date)
(Signature of Duly Authorized Officer of Taxpayer)
(Title)
(Date)
(Signature of Individual Preparing Return)
(Address)
(Phone#)
(Preparers ID#)