Form RDGS "Retail Dealer's Gasoline Shrinkage Refund Application" - Maine

What Is Form RDGS?

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

Form Details:

  • Released on July 1, 2011;
  • The latest edition provided by the Maine Department of Administrative and Financial Services;
  • 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 RDGS by clicking the link below or browse more documents and templates provided by the Maine Department of Administrative and Financial Services.

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Download Form RDGS "Retail Dealer's Gasoline Shrinkage Refund Application" - Maine

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RDGS
Maine Revenue Services
Retail Dealer’s Gasoline Shrinkage
00
Refund Application
*1133000*
Registration No.
Period Begin
Due Date
Period End
01 01 2018
06 30 2018
10 01 2018
1. Entity Information
2.
OUT OF BUSINESS?
Date closed:
3.
OWNERSHIP OR NAME CHANGE?
Date
Explanation
4.
SOLD? Date
ADDRESS CHANGE? Make corrections above and check here
Do Not Use Red Ink!
Please read instructions on reverse side.
Supplier’s Statement
Gallons purchased by retail
Type of Fuel
Applicable
dealer
Tax Collected and Reported
Sold
Tax Rate
(whole gallons only)
,
,
.
,
,
Gasoline
0.300
1.
,
,
.
E10
0.300
2.
,
,
,
,
.
Other
,
,
3.
,
,
.
Other
4.
,
,
,
,
.
Total Tax Paid - Add lines 1-4
5.
,
,
.
Refund Claim - Line 5 X .005
6.
The undersigned states that the above gallonage of gasoline was sold to the above
Mail To:
/
retail dealer for the above period, that payment has been received for such
Maine Revenue Service
P.O. Box 1064
gasoline, and that the undersigned is authorized to make this statement.
Augusta, ME 04332-1064
Date
Name of Supplier
Authorized Signature
This claim is signed under the penalties of perjury.
Date
Signature/Title of Retail Dealer
Printed Name
Phone #
RDGS - Revised 07/2011
For assistance in completing this form, call (207) 624-9609
RDGS
Maine Revenue Services
Retail Dealer’s Gasoline Shrinkage
00
Refund Application
*1133000*
Registration No.
Period Begin
Due Date
Period End
01 01 2018
06 30 2018
10 01 2018
1. Entity Information
2.
OUT OF BUSINESS?
Date closed:
3.
OWNERSHIP OR NAME CHANGE?
Date
Explanation
4.
SOLD? Date
ADDRESS CHANGE? Make corrections above and check here
Do Not Use Red Ink!
Please read instructions on reverse side.
Supplier’s Statement
Gallons purchased by retail
Type of Fuel
Applicable
dealer
Tax Collected and Reported
Sold
Tax Rate
(whole gallons only)
,
,
.
,
,
Gasoline
0.300
1.
,
,
.
E10
0.300
2.
,
,
,
,
.
Other
,
,
3.
,
,
.
Other
4.
,
,
,
,
.
Total Tax Paid - Add lines 1-4
5.
,
,
.
Refund Claim - Line 5 X .005
6.
The undersigned states that the above gallonage of gasoline was sold to the above
Mail To:
/
retail dealer for the above period, that payment has been received for such
Maine Revenue Service
P.O. Box 1064
gasoline, and that the undersigned is authorized to make this statement.
Augusta, ME 04332-1064
Date
Name of Supplier
Authorized Signature
This claim is signed under the penalties of perjury.
Date
Signature/Title of Retail Dealer
Printed Name
Phone #
RDGS - Revised 07/2011
For assistance in completing this form, call (207) 624-9609
Instructions for completing the Retail Dealer’s Gasoline Shrinkage Refund Application
Retail dealers are allowed a semi-annual refund to compensate the dealer for losses due to shrinkage or evaporation to a
maximum of ½ of 1% of tax paid gasoline purchases. For purposes of this refund, a retail dealer is a business that sells
gasoline at retail and delivers the fuel directly into the tanks of a motor vehicle or watercraft. A distributor or wholesaler is a
retail dealer only with respect to gasoline delivered into a retail storage tank operated by that distributor or wholesaler or into
a retail storage tank of a consignee or commission agent.
1. Enter the total tax paid gallons purchased from your supplier between the Period Begin and Period End dates pre-printed
at the top of the form. If you have made purchases from more than one supplier, attach a detailed schedule to the form,
showing only the totals on the refund application. Use the following format:
Supplier Name
Type of Fuel Purchased
Gallons Purchased
Tax Rate
Tax Paid
Contact Maine Revenue Services at 207-624-9609 or at fuel.tax@maine.gov if you have questions about the correct tax rate
to use for gasoline blends. Your supplier should also know the appropriate tax rate.
2. An authorized representative for each supplier is required to sign the refund application verifying the number of gallons
purchased and amount of tax paid is correct.
3. An authorized representative for the retail dealer is required to sign the refund application under the pains of perjury.
Maine Revenue Services imposes penalties for intentionally overstating the amount of a refund due.
The due date is pre-printed in the upper right hand area of the refund application.
Late or incomplete returns will not be accepted.
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