SF-401 SF# 46287 (R2/05-07) Indiana Department of Revenue Transporter's Monthly Tax Return Due date is the 25th of the following month. For the month of: ____________ 20______ Name of License Holder (As indicated on License) Mailing Address (Street or P.O. Box Number) City or Town State Zip Code License Number Telephone Number Federal Identification Number Motor Carrier/IFTA Number Net Gallons From Schedule (Gasoline, Gasohol) (Jet Fuel, Kerosene) 2A 3. Total gallons of fuel loaded from an Indiana terminal or bulk plant and delivered within Indiana. Column C Other Products 1A 2. Total gallons of fuel loaded from an out-of-state terminal or bulk plant and delivered into Indiana. Column B Gasoline (Dyed and Clear Diesel Fuel, Biodiesel and Blended Biodiesel) 1. Total gallons of fuel loaded from an Indiana terminal or bulk plant and delivered to another state. Column A Special Fuel 3A 4. Total gallons of fuel transported (Add lines 1, 2, and 3). Transporter's Schedule of Deliveries Schedules 1A, 2A and 3A must be attached to this report Mail Return To: Indiana Department of Revenue, P.O. Box 6080, Indianapolis, IN 46206-6080 Under penalty of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief it is true, correct, and complete. I further declare that complete and proper records are on file at the address indicated above for all fuel reported on this return. Taxpayer or Authorized Agent Typed or Printed Name Title Date Signed Telephone Number ( ) Important! A return must be filed each month, within 25 days following the last day of the month being reported. Failure to submit this report could result in a civil penalty of $1,000 for each violation. American LegalNet, Inc. www.FormsWorkflow.com Instructions for Completing Fuel Transporter's Monthly Tax Return Schedule SF-401 Who should file this return? Schedule of Deliveries Schedules 1A, 2A and 3A Every person who transports fuel from a point outside Indiana to a point inside Indiana or from a point inside Schedule 1A - Exports: This schedule is to be completed Indiana to a point outside Indiana by truck, barge, rail when transporting fuel from a point inside Indiana to a point outside of Indiana. This reporting requirement and/or pipeline is required to file this return. is not required for exports delivered by vehicles with a capacity of less than 5,400 gallons. Exports in vehicles When is the return due? with a capacity greater than 5,400 gallons would be The Fuel Transporter’s Monthly Tax Return, Form SF- reported as follows: 401, and supporting schedules are due by the 25th day of the month following the month for which the return is 1) Loads/Deliveries to a single location greater than being filed. Example: A return for the reporting period 500 gallons must be itemized on Schedule 1A. All information must be completed for each of these of January is due by the 25th of February. transactions. How do I complete the SF-401? 2) Loads/Deliveries to a single location of 500 gallons Indicate at the top of the return the reporting period for or less may be grouped together and reported as which you are filing. Enter your company’s identifying “Various." information as indicated on your Indiana Fuel License. Schedule 2A - Imports: This schedule is to be completed Line 1 Enter the total gallons of fuel transported by you when transporting fuel from a point outside of Indiana to a point inside Indiana. This reporting requirement to another state from Schedule 1A-Exports. includes all vehicles, regardless of capacity. Each load/delivery imported must be listed regardless of the Line 2 Enter the total gallons of fuel transported by you from another state into Indiana from attached Schedule number of gallons. 2A - Imports. Schedule 3A - In-State Transfers: This schedule Line 3 Enter the total gallons of fuel loaded from an should be completed when transporting fuel from a point Indiana terminal or bulk plant and transported by you starting inside Indiana to a point ending in Indiana. This within the state of Indiana from Schedule 3A - Instate reporting requirement is not required for vehicles with a capacity of less than 5,400 gallons. Each load/delivery Transfers. imported in a vehicle over 5,400 gallons must be listed regardless of the number of gallons imported. Line 4 Enter the total gallons of fuel transported. (Add lines 1, 2, and 3.) Reminder! Be sure to sign and date your return. Failure to do so may result in penalties for filing an incomplete return. American LegalNet, Inc. www.FormsWorkflow.com