Form M-22 - Quarterly Tax Return For Additional Fuel Taxes Due On Fuel Initially Purchased For Use Off The Public Highways But Subsequently Used On The Public Highways Form - State Of Hawaii - Department Of Taxation

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TO BE FILED

FORM M-22

STATE OF HAWAII—DEPARTMENT OF TAXATION

BY END USER

QUARTERLY TAX RETURN FOR ADDITIONAL FUEL TAXES DUE

(REV. 2006)

ON FUEL INITIALLY PURCHASED FOR USE OFF THE

PUBLIC HIGHWAYS BUT SUBSEQUENTLY USED ON THE PUBLIC HIGHWAYS

Name

FEIN or SSN

NOTE: This return with

Please

payment

must

submitted

the

Business address (Number and Street)

Period Beginning

Department of Taxation

on or before the last day

of the month following

Type

City, State, ZIP code

Period Ending

the close of the filing

period.

PART I — DIESEL OIL

(a)

(b)

(c)

(d)

(e)

CITY AND COUNTY

COUNTY OF MAUI*

COUNTY OF HAWAII

COUNTY OF KAUAI

TOTAL TAX DUE

OF HONOLULU

(add cols. a thru d)

1. (a) Gallons purchased where

only 1¢ tax previously paid

(b) Tax Rate

31.5¢

33¢

/31¢

23.8¢

28¢

line 1(a) by 1(b) of cols. a thru d

2. (a) Gallons purchased where

NO tax was previously paid

(b) Tax Rate

32.5¢

34¢

/32¢

24.8¢

29¢

line 2(a) by 2(b) of cols. a thru d

3. TOTAL DIESEL OIL TAX DUE — Add column (e), lines 1(c) and 2(c) · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · ·

4. *For the County of Maui, specify and separately show the number of gallons used in Lanai and Molokai

Lanai

Molokai

Effective July 1, 2003, pursuant to Maui County Resolution No. 03-65.

Pursuant to City and County of Honolulu Resolution No. 02-55.

Effective July 1, 2006, pursuant to Maui County Resolution No. 06-44.

PART II — ALTERNATIVE

(a)

(b)

(c)

(d)

(e)

FUEL

CITY AND COUNTY

COUNTY OF MAUI*

COUNTY OF HAWAII

COUNTY OF KAUAI

TOTAL TAX DUE

OF HONOLULU

(add cols. a thru d)

5. (a) Type/Gallons purchased where

NO tax was previously paid

(b) Tax Rate (see Instructions)

line 5(a) by 5(b) of cols. a thru d

6. *For the County of Maui, specify and separately show the number of gallons used in Lanai and Molokai

Lanai

Molokai

PART III — TOTAL TAXES NOW DUE AND PAYABLE

Add lines 3 and 5(c), column (e). Enter the amount here. (Make your check payable to "Hawaii State Tax Collector" in U.S. Dollars drawn on any U.S. Bank)

DECLARATION

I declare, under the penalties set forth in section 231-36, HRS, that this is a true, correct, and complete return, prepared in accordance with the provisions of chapter 243, HRS, the

Fuel Tax Law, and chapter 18-243, HAR.

SIGNATURE

TITLE

DATE

MAILING ADDRESS

Hawaii Department of Taxation

P. O. Box 259

Honolulu. Hawaii 96809-0259

Telephone: 808-587-4242

Toll-Free 1-800-222-3229

FORM M-22