Form FT-441-753 "Motor Vehicle Fuel Supplier Tax Return" - Washington

Form FT-441-753 or the "Motor Vehicle Fuel Supplier Tax Return" is a form issued by the Washington State Department of Licensing.

Download a PDF version of the Form FT-441-753 down below or find it on the Washington State Department of Licensing Forms website.

Step-by-step Form 441-753 instructions can be downloaded by clicking this link.

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Download Form FT-441-753 "Motor Vehicle Fuel Supplier Tax Return" - Washington

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Click here to START or CLEAR, then hit the TAB button
Motor Vehicle Fuel Supplier
Tax Return
See next page for where to send this form.
A. Reporting period
For validation only. 108-030-115-0001
Year
Month
License number
B.
No operations
Amended return
New address
Effective date
Late return
Name change
Cancel license
C. Name and address
Validated postmark date
1 Beginning physical inventory
1
2 Fuel received (total from Receipts schedule on page 2)
2
3 Ending physical inventory
3
4 Total accountable gallons (line 1 + line 2 - line 3)
4
5 Tax-exempt gallons (total from Disbursements schedule on page 2)
5
6 Taxable gallons (line 4 - line 5)
6
7 Tax-paid gallons received (Receipts schedule on page 2, line R1)
7
8 Total of motor fuel allowances (from Motor fuel allowance on page 2, line 6)
8
9 Net taxable or credit gallons (line 6 - line 7 - line 8)
9
10 Motor vehicle fuel tax (line 9 x $.375 before Aug. 2015)
10
11 Penalty after 25th of the month (line 10 x 2%)
11
12 Sum of line 10 + line 11
12
13 Interest (line 12 x 1% compounded monthly)
13
14 Total fuel tax (line 12 + line 13)
14
15 Previous payments for this reporting period
15
16 Credit for non-payment of tax from purchaser *
16
17 Total adjustments (line 15 + line 16)
17
EFT
18 If total of line 14 - line 17 is greater than zero, amount owed
18
19 If total of line 14 - line 17 is less than zero, net refund amount
19
(
)
Printed name of person signing
Contact name (If different from person signing)
Contact (area code) telephone number
Contact (area code) fax number
Contact email address
I certify under penalty of perjury under the laws of the state of Washington that the foregoing is true and correct.
X
When you have completed this form, please print it out and sign here.
Date and place
Signature
Please keep a copy of this tax return for your records.
FT-441-753 (R/5/18)WA Page 1 of 2
Click here to START or CLEAR, then hit the TAB button
Motor Vehicle Fuel Supplier
Tax Return
See next page for where to send this form.
A. Reporting period
For validation only. 108-030-115-0001
Year
Month
License number
B.
No operations
Amended return
New address
Effective date
Late return
Name change
Cancel license
C. Name and address
Validated postmark date
1 Beginning physical inventory
1
2 Fuel received (total from Receipts schedule on page 2)
2
3 Ending physical inventory
3
4 Total accountable gallons (line 1 + line 2 - line 3)
4
5 Tax-exempt gallons (total from Disbursements schedule on page 2)
5
6 Taxable gallons (line 4 - line 5)
6
7 Tax-paid gallons received (Receipts schedule on page 2, line R1)
7
8 Total of motor fuel allowances (from Motor fuel allowance on page 2, line 6)
8
9 Net taxable or credit gallons (line 6 - line 7 - line 8)
9
10 Motor vehicle fuel tax (line 9 x $.375 before Aug. 2015)
10
11 Penalty after 25th of the month (line 10 x 2%)
11
12 Sum of line 10 + line 11
12
13 Interest (line 12 x 1% compounded monthly)
13
14 Total fuel tax (line 12 + line 13)
14
15 Previous payments for this reporting period
15
16 Credit for non-payment of tax from purchaser *
16
17 Total adjustments (line 15 + line 16)
17
EFT
18 If total of line 14 - line 17 is greater than zero, amount owed
18
19 If total of line 14 - line 17 is less than zero, net refund amount
19
(
)
Printed name of person signing
Contact name (If different from person signing)
Contact (area code) telephone number
Contact (area code) fax number
Contact email address
I certify under penalty of perjury under the laws of the state of Washington that the foregoing is true and correct.
X
When you have completed this form, please print it out and sign here.
Date and place
Signature
Please keep a copy of this tax return for your records.
FT-441-753 (R/5/18)WA Page 1 of 2
Motor Vehicle Fuel Supplier Tax Return
Name
License number
Inventory
Motor vehicle fuel
Ethanol
Total
Beginning
+
=
Page 1, line 1
Ending
+
=
Page 1, line 3
Receipts schedule
R1
Tax-paid gallons received *
R1
R2a Imported gallons received direct to customer * *
R2a
R2b Imported direct to licensed terminal rack * *
R2b
R3
Non-taxed gallons received or produced * *
R3
(including gains from bulk storage,
R5
Other * *
(explain)
R5
temperature adjustments, and transportation)
Total fuel received (sum of lines R1 through R5)
page 1, line 2
Disbursements schedule - Tax exempt
D1
Sales to Washington licensed suppliers *
D1
D2
Export sales *
D2
D3
Sales to foreign governments *
D3
D4
Sales to licensed exporters *
D4
D5
Sales to U.S. Armed Forces or National Guard for export *
D5
D9
Other * * (explain)
D9
D11 Sales to authorized tribal entities * *
D11
Total exempt gallons (sum of lines D1 through D11)
page 1, line 5
Sales to
licensed
All other
distributors
taxable sales
Motor fuel allowance
A
B
1
Taxable gallons (page 1, line 6)
2
Tax-paid gallons received (page 1, line 7)
3
Total of line 1 - line 2
0.0031
0.0025
4
Taxable allowance rate
5
Taxable allowance gallons (line 3 x line 4 each column)
6
Total allowance (sum of line 5 columns A and B
Page1, line 8
* Support schedule required
* * One support schedule for each category required
If payment is enclosed, send this completed form and supporting documents to: Prorate and Fuel
Tax, Department of Licensing, PO Box 9048, Olympia, WA 98507-9048
If payment is not enclosed, send this completed form and supporting documents to:
Fuel Tax Unit, Department of Licensing, PO Box 9228, Olympia, WA 98507-9228 or fax to (360) 570-7842
FT-441-753 (R/5/18)WA Page 2 of 2
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