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Recap Of Prepaid Sales Tax By Distributors Form. This is a Indiana form and can be use in Department Of Revenue Statewide.
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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. ____/____/____
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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
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