Indiana > Statewide > Department Of Revenue > Sales And Withholding
Recap Of Prepaid Sales Tax By Distributors ST-103DR - Indiana
| Recap Of Prepaid Sales Tax By Distributors Form. This is a Indiana form and can be used in Sales And Withholding Department Of Revenue Statewide . |
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Form ST-103DR State Form 51068 (R4 / 9-12) Indiana Department of Revenue Recap of Prepaid Sales Tax by Distributors IMPORTANT: This form must be filed even when no transactions have occured. 2. For Tax Period (month/year) / 5. Doing Business as Name (DBA) 3. Federal Identification Number 6. Telephone Number 1. Taxpayer Identification Number 4. Taxpayer Name 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 12. Supplier Federal ID Number 13. Total Gallons Purchased 14. Prepaid Sales Tax Paid to Supplier Note: You Must Complete BOTH Sides of this Form 15. Grand Totals Instructions for Section I 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. Provide your Indiana Taxpayer Identification Number (TID). What Tax Period (month/year) Note: This report is due the last day of the month following the reporting period. Enter your Federal Identification Number (FID). Provide the Taxpayer's legal name. List the Doing Business as Name for your company. Please list your company's telephone number including area code. Provide your business address. Check your Distributor Status. Check which tax return you are filing. List the names of the companies you purchase from. List the address of the companies you purchase from. List your supplier's Federal Identification Number. List total gallons purchased from each supplier. Provide the amount of prepaid sales tax you paid each supplier. Total the number of gallons purchased and the amount of prepaid sales tax paid for the reporting month. 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 17. Customer's Address To Whom Did You Sell Fuel? 18. Customer's Federal ID Number 19. Total Gallons Sold 20. Exempt Gallons Sold 21. Prepaid RST Collected All Gallons EXEMPTED and TAXED must be shown 22. Total Instructions for Section II 16. 17. 18. 19. 20. 21. 22. 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. List the total amount of Prepaid Sales Tax collected for this month from each customer. Total the amounts of all columns and give the total gallonage and amount collected here. Mail to: Indiana Department of Revenue Excise Tax P.O. Box 6114 Indianapolis, IN 46206-6114 (317) 615-2552 I declare, under penalties of perjury that this is a true, correct and complete report. ______________________________________________ Printed Name _____________________________________________ Authorized Signature __________________________ Title ________________ Date American LegalNet, Inc. www.FormsWorkFlow.com
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