Recap Of Prepaid Sales Tax By Distributors Form. This is a Indiana form and can be use in Department Of Revenue Statewide.
Tags: Recap Of Prepaid Sales Tax By Distributors, ST-103DR, Indiana Statewide, Department Of Revenue
Form ST-103DR SF# 51068 (R3 / 1-08) Indiana Department of Revenue Recap of Prepaid Sales Tax by Distributors IMPORTANT:This form must be ﬁled even when no transactions have occured. 1. Taxpayer Identiﬁcation Number (TID) 2. For Tax Period (month/year) 3. Federal Identiﬁcation Number (FID) / 4. Taxpayer Name 5. Doing Business as Name (DBA) 6. Telephone Number ( 7. Street Address, City, State, Zip Code ) - 8. Gasoline Distributor Status (Check One) Qualiﬁed Distributor Non-Qualiﬁed Distributor 9. Which sales tax return are you ﬁling (Check One) ST-103 ST-103MP None NOTE: THIS FORM MUST BE PRINTED OR TYPED Section I: 10. Name of Supplier From Whom Did You Buy Fuel? 11. Address of Supplier Note: You Must Complete BOTH Sides of this Form 12. Supplier Federal ID 15. Grand Totals 13. Total Gallons Purchased a 14. Prepaid Sales Tax Paid to Supplier b Instructions for Section I 1. Provide your Indiana Taxpayer Identiﬁcation Number (TID). 2. What Tax Period (month/year) Note: This report is due the last day of the month following the reporting period. 3. Enter your Federal Identiﬁcation Number (FID). 4. Provide the Taxpayer’s legal name. 5. List the Doing Business as Name for your company. 6. Please list your company’s telephone number including area code. 7. Provide your business address. 8. Check your Distributor Status. 9. Check which tax return you are ﬁling. 10. List the names of the companies you purchase from. 11. List the address of the companies you purchase from. 12. List your supplier’s Federal Identiﬁcation Number. 13. List total gallons purchased from each supplier. 14. Provide the amount of prepaid sales tax you paid each supplier. 15. Total the number of gallons purchased and the amount of prepaid sales tax paid for the reporting month . A This report must be ﬁled MONTHLY. It is due on the last day of the month following the reporting period. Please check this box if your business has permanently closed and provide the closed date. ____/____/____ American LegalNet, Inc. www.FormsWorkflow.com SECTION II 16. Customer’s Name To Whom Did You Sell Fuel? 17. Customer’s Address All Gallons EXEMPTED and TAXED must be shown 18. Customer’s FID# 22. Total 19. Total Gallons Sold a 20. Exempt Gallons Sold b 21. Prepaid RST Collected c Instructions for Section II 16. 17. 18. 19. 20. List your Customer’s Name. (Attach additional sheets if necessary). List your Customer’s Address. List your Customer’s Federal ID Number. List the total gallons of gasoline sold for this month to each customer. List the total tax exempt gallons sold to each customer. 21. List the total amount of Prepaid Sales Tax collected for this month from each customer. 22. Total the amounts of all columns and give the total gallonage and amount collected here. I declare, under penalties of perjury that this is a true, correct and complete report. C B Printed Name Mail to: Indiana Department of Revenue Excise Tax P.O. Box 6114 Indianapolis, IN 46206-6114 Authorized Signature Title Date American LegalNet, Inc. www.FormsWorkflow.com