Form T-12 Motor Fuel Special Distribution Tax Report - Rhode Island

Form T-12 is a Rhode Island Department of Revenue form also known as the "Motor Fuel Special Distribution Tax Report". The latest edition of the form was released in September 1, 2013 and is available for digital filing.

Download a fillable PDF version of the Form T-12 down below or find it on Rhode Island Department of Revenue Forms website.

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State of Rhode Island and Providence Plantations
Form T-12
Motor Fuel Special Distributor Tax Report
Distributor name
Federal employer identification number
Address
For the month ending:
MM/DD/YYYY
Address 2
City, town or post office
State
ZIP code
E-mail address
This report must be filed with the RI Division of Taxation by the 20th day of the month following the month for which the motor fuel was
sold or used by the person making this report. Payment of all motor fuel tax due must be made with this report.
Schedule A - Tax Computation
Amount
Gallons
1
Total motor fuel sold from Schedule C.....................................................................
1
2
Total motor fuel used by company making this report..............................................
2
Gallons sold or used upon which tax had been paid to supplier..............................
3
3
4
Adjusted motor fuel sold or used. Subtract line 3 from the total of lines 1 and 2....
4
5
Adjustments on prior month(s) report.............................................................................
5
Total gallons of motor fuel subject to tax. Combine lines 4 and 5................................
6
Total motor fuel tax due. Multiply line 6 by the current tax rate..................................................................................
7
7
Schedule B - Tax Paid Information in Gallons
Name of suppliers:
Beginning inventory:
Ending inventory:
Purchases:
Sales:
Total:
Total
:
Under penalties of perjury, I declare that I have examined this return and accompanying schedules and statements, and to the best of my knowledge and
belief, it is true, accurate and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.
Authorized officer signature
Print name
Date
Telephone number
Paid preparer signature
Print name
Date
Telephone number
Paid preparer address
City, town or post office
State
ZIP Code
PTIN
May the Division of Taxation contact your preparer? YES
Revised 09/2013
Key #7
State of Rhode Island and Providence Plantations
Form T-12
Motor Fuel Special Distributor Tax Report
Distributor name
Federal employer identification number
Address
For the month ending:
MM/DD/YYYY
Address 2
City, town or post office
State
ZIP code
E-mail address
This report must be filed with the RI Division of Taxation by the 20th day of the month following the month for which the motor fuel was
sold or used by the person making this report. Payment of all motor fuel tax due must be made with this report.
Schedule A - Tax Computation
Amount
Gallons
1
Total motor fuel sold from Schedule C.....................................................................
1
2
Total motor fuel used by company making this report..............................................
2
Gallons sold or used upon which tax had been paid to supplier..............................
3
3
4
Adjusted motor fuel sold or used. Subtract line 3 from the total of lines 1 and 2....
4
5
Adjustments on prior month(s) report.............................................................................
5
Total gallons of motor fuel subject to tax. Combine lines 4 and 5................................
6
Total motor fuel tax due. Multiply line 6 by the current tax rate..................................................................................
7
7
Schedule B - Tax Paid Information in Gallons
Name of suppliers:
Beginning inventory:
Ending inventory:
Purchases:
Sales:
Total:
Total
:
Under penalties of perjury, I declare that I have examined this return and accompanying schedules and statements, and to the best of my knowledge and
belief, it is true, accurate and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.
Authorized officer signature
Print name
Date
Telephone number
Paid preparer signature
Print name
Date
Telephone number
Paid preparer address
City, town or post office
State
ZIP Code
PTIN
May the Division of Taxation contact your preparer? YES
Revised 09/2013
Key #7
State of Rhode Island and Providence Plantations
Form T-12
Motor Fuel Special Distributor Tax Report
Distributor name
Federal employer identification number
Schedule C - Itemized Sales
Gallons
Date (MM/DD/YYYY)
Name of Purchaser
Address
Diesel
Total gallons of diesel. Add all amounts in the “Diesel” column.
Total gallons of LPG. Add all amounts in the “LPG” column.
Total of all gallons. Add the total gallons of diesel and LPG. Enter here and on pg 1, Sch A, line 1.

Download Form T-12 Motor Fuel Special Distribution Tax Report - Rhode Island

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