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Michigan Department of Treasury

This form is issued under authority of P.A. 244 of

429 (Rev. 9-04)

1983. Filing of this form is voluntary, but the form

Gasoline Supplier and Wholesale

must be filed for credit to be allowed.

Distributor Prepaid Sales Tax Report

NOTE

Effective with returns for January 1993, this credit cannot be taken against Gasoline Tax. File this form with your Discount

Voucher (Form 161) or Combined Return (Form 160). If you are not required to file a return, mail this form directly to Michigan

Department of Treasury, Lansing, MI 48922.

GENERAL INFORMATION

This supplemental report is used by the wholesaler for three

(Line-By-Line Instructions for Wholesalers). This will give

purposes:

credit for retail sales and out-of-state sales. It will also account

for over collections because of blending. (NOTE: Wholesalers

To claim credit for prepayments made on retail sales;

who

blend

alcohol

and

gasoline

should

recover

the

To account for over-collection of the prepayment because of

prepayment on sales to retailers or other wholesalers at the

blending of alcohol and gasoline by a wholesaler; and

full rate on the total gallons of blended gasoline.)

To allow credit for sales of gasoline on which prepayments

were made and which were delivered to out-of-state locations.

Wholesalers who have no sales, use or withholding tax

Wholesalers should complete lines 1 through 11 as directed in

liability on a continuing basis, see instructions on the

the instructions at the top of the reverse side of this form

reverse side of this form.

Wholesalers who make no retail sales, make no deliveries to out-of-state locations and do not blend gasoline, do not use

this form. You will recover all of your prepayments through sales to retailers or other wholesalers.

SEE LINE-BY-LINE INSTRUCTIONS ON THE BACK OF THIS FORM.

2. Registered Business Name

Account No.

Address

City

State

Zip

Return Period Month-Year

DOLLARS

Total Amount Due. Enter the amount from discount voucher (161), Total

Payment line or combined return (160), Total Payment line

GALLONS

Total Payments Less Adjustments

Prior month ending gasoline inventory on which tax was prepaid

Purchases on which tax was prepaid to the state (Form 173) or to

the supplier during return period.

Check here if OUT-OF-STATE DELIVERY

Add lines 6a and 6b

Ending wholesale plus retail gasoline inventory for return period

Alcohol or other agents blended during return period. Multiply gallons

by current prepayment rate and enter amount under dollars.

See instructions.

Add lines 6d and 6e

Adjusted prepayments. Subtract line 6f from line 6c

Amount of prepaid tax recovered on sales to wholesalers and/or retailers.

Do not include amounts on line 6e

Net Amount Prepaid. Subtract (in dollars column) line 7 from line 6g.

If negative amount, it is tax due. Add to line 5 and pay total

Sales Tax Collections Discount. Enter 2/3 (.6667) of line 8

. See instructions

10.

Add lines 8 and 9.

11.

NET PAYMENT DUE. Subtract line 10 from line 5.

See instructions for information on making payment

Form 429 - Gasoline Supplier And Wholesale Distributor Prepaid Sales Tax Report - 2004

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