Form Wv/mft-506 - Motor Fuel Backup Tax Report - West Virginia State Tax Department
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1
2WV/MFT-506
Org. 11/03
U
WEST VIRGINIA STATE TAX DEPARTMENT
INTERNAL AUDITING DIVISION
PO BOX 2991
CHARLESTON, WV 25330-2991
(304) 558-8500
MOTOR FUEL BACKUP TAX REPORT
(No return is required to be filed if there is no reportable activity)
The Operator of a Highway Vehicle That Uses Untaxed or Refunded Motor Fuel That Is Taxable Under WV§11-14C Is Liable for the Tax.
You must keep a copy of this report for your records
(Check applicable boxes)
□ Address has changed since prior return
□ Amended Report
□ Final Return for closed business
Please Print in Ink or Type
TAXPAYER INFORMATION
FEIN/SSN
Name
Report Month and Year
Mailing Address
City
State
Zip Code
Telephone Number
Fax Number
E-mail Address
(
)
(
)
TAX/REFUND COMPUTATION
SCHEDULE INFORMATION
1
-
TOTAL GALLONS
Flat Rate ($0.2050) exempt Motor Fuel that was consumed on-highway.
-
2
TOTAL GALLONS
Motor Fuel consumed on-highway after an application for a refund of tax paid is made/allowed.
TAX COMPUTATION
- Exempt fuel that was consumed on-highway. (Multiply Line 1 by $0.2050)
3
TAX DUE
$
4
TAX DUE
- Refunded Motor Fuel used on-highway. (Multiply Line 2 by $0.2050)
$
TOTAL TAX COMPUTATION
5
TOTAL TAX DUE
. (Add Lines 3 and 4)
$
6 If Amended Return - Enter amount paid on original.
$
7
. (If Line 5 is greater than Line 6, subtract Line 6 from Line 5, otherwise enter -0-)
NET TAX DUE
$
8
. (If Line 6 is greater than Line 5, subtract Line 5 from Line 6, otherwise enter -0-)
NET REFUND DUE
$
CERTIFICATION
I certify that I have read this report and all supporting documents and know their contents and that all information on both the report and supporting documents are
true, accurate, and complete.
Authorized Representative’s Name (Please Print)
Title
Authorized Representative’s Signature
Date
Telephone Number
Fax Number
E-mail Address
(
)
(
)
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