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Home My WebLink AboutReel_0056E SPitAL FUEL USER'S TAX REPORT . SlATE OF WASHINGTON-DEPARTMENT OF L!C~NSING FIRM NAME "~ u. '! SPECIAL FUEL LICENSE NO. .. I j , ~ ^ : REPORTING PERIOD-MONTH June o NO OPERATIONS DURING MONTH D THIS IS A FINAL REPORT - OPERATIONS IN WASHINGTON HAVE BEEN TERMINATED D LICENSE IS RETURNED FOR CANCELLATION NO. OF VEHICLES OPERATED INTO ANDIOR IN WASHINGTON MAILING ADDRESS i; r,,,I;U<', .-,.".;.,' i 10 F" \, ,", CITY, STATE. '" ZIP S><OW......CH....GE'........t ..tll".lSSOHO.....lH5..'.. S,NCtP"EGLP,.."HI""'" USE SPECIAL FUEL INSTRUCTION SHEET AS A GUIDE WHILE COMPLETING THIS FORM GALLONS OF FUEL USED TO OPERATE POWEA PUMPING UNITS OR POWER TAKE-OFF eQUIPMENT rA, ON OCLIVERr TRUCIIS PUMPING PROPANE. FUEL OILS. OR /;EArWG OILS, OR MEASURED BY UfTHllNCl DEVICE APPROVED 8Y THE DCPT .FIlOM SCHEDUlf "8 (8) ON CCMENT M/7C1I5 "NO lD"D COMPACTOR OAIlBAor TRUCi'(S.f110M SCHeDULE 'C. DIESEL (DIESEL ONLY) 728 91 8 728 91 0 0 0 0 0 0 :<' 91 COMPUTATION OF TAXABLE GALLONS 1. MILES TRAVELED IN ALL STATES (INCLUDING CANADIAN PROVINCES) TOTAL GALLONS OF FUEL USED IN ALL STATES (INCLUDING CANADIAN PROVINCES) AVERAGE MILES PER GALLON (LINE 1 DIVIDED BY LINE 2) ROUND TO TWO DECIMAL PLACES (0.00) I t...1ILES TRAVE.LED ON WASHINGTON PUBLIC ROADS. TOTAL GALLONS OF FUEL USED ON WASHINGTON PUBLIC ROADS (LINE 4 DIVIDED BY LINE 31 ROUND TO THE NEAREST WHOLE GALLON DEDUCTIONS (USE COMPUTA nON SCHEDULES ON REVERSE SIDE) GALLONS OF FUEL PURCHASED IN WASHINGTON SPECIAl. (A) FROM SERVICE STATION, KEYLOCK. OR OTHER FACILITIES FUEL TAlC PAID DELIVERED INTO VEHICLE FUEL SUPPLY TANKS (B) TAX PAID WITHDRAWALS FROM YOUR OWN BULK STORAGE. GALLONS OF FUEL USED IN MOTOR VEHICLES EXEMPT FROM SPECIAL FUEL TAX - FROM SCHEDULE "A" TOTAL GALLONS DEDUCTIBLE (ADD LINES 6 THROUGH 8) NET TAXABLE GALLONS TOTAL GALLONS ON WHICH TAX (OR CREDIT) IS DUE (SUBTRACT LINE 9 FROM LINE 5J IF LINE 9 IS GREATER THAN LINE 5 INDICATE CREDIT BY PARENTHESES COMPUTATION Of TAX DUE TAX DUE FOR REPORTING PERIOD TAX Due (OR CREDIT I( '...: e PER GALLON ON GALLONS SHOWN ON LINE tD) INDICATE CREDIT BY PARENTHESES ----- PENAL TV FOR FILING AFTER 25TH OF MONTH (10 PERCENT OF LINE") INTEREST FOR FILING AFTER 25TH OF MONTH (1 PERCENT OF LINE 11) TOTAL OUE (OR CREDIT) FOR REPORTING PERIOD (ADO LINES 11 THROUGH 13) INDICATE CREDIT BV PARENTHESES TAX ADJUSTMENT FROM PRIOR REPORTS TAX ASSESSMENTS (OR TAX CREDITS) FADM PREVIOUS MONTHIS), INDICATE CREDIT BY PARENTHESES, NET AMOUNT OF TAX lOR CREDIT) DUE, (LINE .4AND 15), 'INDICATE CREDIT BY PARENTHESES, MAKE REMITTANCE PAYABLE TO STATE TREASURER. (NOTE MAILING INSTRUCTIONS ON REveRSE SIDE) 'REfUND or A. lAX CREDIT ON liNt 16 MAY DE CLA.IMED ON TtilS REPORT IN LIEU or fiLING A CLAIM rOR RCrUND o CHECK OOX If YOU WISH TO APPLY FOR REFUND OF OUTSTANDING TAX CREDIT AT THIS TIME I crA"'" UNOl" tHI "N.UI!I 0' "'",/V", '''AT THI. "'.-oAT, INCLUOINQ aNY ..CCO.....NYING aCHIOUL'I OR ITATf"'NTI,'1 TO THE lilt 0' MY KNOWl.IOOr TAUI., CO""ICT ....0 COMlt\rU MQNAnJIU: X F ~.A.~U-A-,h.-../ llTlE Director. Dept. of Public Works ft~:!;INC'ioS p.,<<)~-350S f'f'l[P~f'lr:o A1laJ:.Uovnaand.-w.A--98368- DAlE ~_U'llL ............" IIL...-,,'.l '"" ii,',' >". ,. .......' ....; ..".' ....... 'i>.........,.{ ......................... ;i:"Y i/i> ....... < ;{i '.'i. ..... ....., ......' , .</. i/, ....... ."'. ';'.\', .... C":'' .;_>"- .. .:i;: Yo-i", . ....... i., ....... ... ....i,._ ""." '; '.(;; (, .C, j; i. .... ........ ::. .' .', 'i ~~.l. . DEDUCTION DETAILS. III' MOAE SPACE 15 NEEDED. ATT"CH SEPARATE SHEETS) SCHEDULE A. _~~I~OI~~t~~~~o~n s;;e~~~.lngton public roads In motor \lehlcles exempt by statute from special fuel tax, Claim ere " or gallons 0 SpeCl8 uol used on Wash nglon publiC roads while operating: An urban transportation system over a preSCrlbed route within 8 25 mile radius 01 corporate county limits. VEHICLE OR lOTAL aALLONS DELIVERED aALLONS USED ON RATE G.a.LLONS SUBJECT TO CREDIT FLEET NUIolBER INTO \/EHICLES WASHINGrON PUBUC ROADS DIESEL ----------- ----------------- ----------------- (100GIo) ----------------- - - - - -(100%) - - -- , ----------- ----------------- ----------------- - - -- -(1000/0)---- ----------------- ----------- ----------------- ----------------- -----(100%)---- .----------------- ----------- ----------------- ----------------- -----"oo;;.r---- ----------------- .. - ' . .. . .,,, .--; ----------- ----------------- ----------------- =====(i~~[==== ----------------- ----------- ------------------ ----------------- ----------------- ----------- ----------------- ----------------- (100%) ----------------- - ----(1OCWo)"---- CARRY TOTAL. ROUNDED TO NEAREST WHOLE GALLON. TO LINE 7 TOTAL GALLONS _ Gallons used In Washington to operate power pumping units or power take-off equipment (a) on de,livery trucks pumping propane, SCHEDULE B- fuel oils or heating oils or (b) lor other purposes if motor vehicle Is equipped with a metering device appro\led by the department. (see instruction sheet _ Claim .credlt for, three-fourths of a gallon for each 1000 gallons pumped, Example: (140,000 x .00075 ::: 105 credit gallons) VE....ICLEOA CEUVCRV MEIER REACINGS TOT~~~:i~ONS.. .. RATE GALLONS SUBJECT TO CREDIT rLEET NUMBER '"0 START DIESEL ----------- -------------------- -------------------- ----------- (,00075) ----------------- ----(".00075)- --- ----------- -------------------- -------------------- ----------- ----;.00'(75)" ---- ----------------- ----------- -------------------- -------------------- ----------- ----;.00(75)"---- ----------------- ----------- -------------------- -------------------- ----------- - - - - '(.00075) - - -- ----------------- ----------- -------------------- -------------------- ----------- ----'(.00075)---- ----------------- ----------- -------------------- -------------------- ----------- - -- -'(.00075)- --- ----------------- ----------- -------------------- -------------------- ----------- ----"(.00075}---- ----------------- CARRY TOTAL. ROUNDED TO NEAREST WHOLE GALLON, TO LINE 8 (AI, TOTAL' GALLONS --. SCHEOULE C- Oallons used In Washington to operate a powar 181<e-off unit on ceme'nt mixer trucks and load compactors on garbage truck,s. (see Instruction sheel) Claim credit for 25% of the gallons .of special fuel used in Washington. Example: (3000 gallons x .25 . 750 credit gallons) VlHICLI! 0" TOTAL QALLONS DE1.l\ItREo MilES TRAVELED O"'LLO~9 USEO RATE QAlLO~9 SUSJECT TO CREDIT nUT HIJUIU~A I'oITDVEHICLE5 I~ WASHINGTON IN WAStilNOrON OIfSEL ----------- ----------------- ----------------- ----------------- (.20) ----------------- - ---- (.ioi----- i ----------- ----------------- ----------------- ----------------- -- -- - (.i5i n n_ ----------------- ----------- ----------------- ----------------- ----------------- -- ---'(.20")----- ----------------- ----------- ----------------- ----------------- ----------------- - -- n (.ioi n --- ----------------- --------.-- ----------------- ----------------- ----------------- - n__ (.ioi -- --- ----------------- ---------..- ----------------- ----------------- ----------------- - -- -- (.25i- _n_ ----------------- ---------..- -----~----------- ----------------- ----------------- --n-(.ioi-n-- ----------------- CARRY TOTAL. ROUNDED TO NEAREST WHOLE GALLON. TO LINE 8, (8) TOTAL GALLONS _ FII. Ih.. .- and remllt~ WIIIl Ih. Slllle o' Washlnglon, O.,parlmfln, of Llconting. FUfll r.. Oivillon. PO BOX 9228, OIVmpia, W"hlnglon 98504 AVOID PENAL TIES Report. a'. du. on 0' btrlo,o 'h. 2Slh d., 0' lno month lollowlng '" A charge 0' 10 porconl pIUlmlo,o,1 .. :ne ralt! 01 1 perce"' por month 01 'ho flU duo will .. ......dd '0< I.te reporlt Ol,..cl In'1U1not '0 1M fuol r.. DIVISion 0< Tlthtphor'ltt (2(6) 153-6900 DISTRIBUTION: ORIGINA~: To Departmont of Licensing DUPLICATE. Special fuel ultU', copy ,: I';' 'iX.... :,' "'.:,: ',".,'", yr. I,i.:. it'. ". ). :r ',".'.,.:' .',': ., iiX< ~'i,";"...,....,o' '. "'<"'..' '.i......,',,'!,: ,f: ,:r:;-:,; '.....;, ">:::,,''-, ;" .'.....,....<.: ..:y,' ....'i.. "", '....X:/' . '.'., X' :'"i : " ........:............ ,; .{.':" ,,,. .;- ...... :., Y" .' '-- I ;:~ ......:... SF8IAL FUEL USER'S TAX REPORT stATE OF WA,SHINGTON_DEPARTMENT OF MOTOR VEHICLES . FUEL TAX DIVISION P.O. BOX 2228 OLYMPIA, WASHINGTON 98504 ;'.' , SPECIAL FUEL LICENSE NO. ,', ~f (d'~ - r C ~.~. ':' ~,. .; ,";; . REPORTING PERIOD-MONTH December D NO OPERATIONS DURING MONTH D J;J11~Hlri~~td~ARA~lt~~lN. .ptRE&i~~f'~~ IN D LICENSE IS RETURNED FOR CANCELLATION NO. OF VEHICLES OPERATED INTO AND/OR IN WASHINGTON ,; l\,..)U' USE SPECIAL FUEL INSTRUCTION SHEET AS A GUIDE WHILE COMPLETING THIS FORM COMPUTATION OF. TAXABLE GALLONS. 'GA":LONSSUSJECT1'O TAX-(SHOWSEPARATE MILES AND GALLONS FOR DIESEL FROM OTHER SPECIAL FUeLS) :' DIESEL:; __. '0, OTHER::' (DIESEL ONL VI B .::::: ,.. ,... MILES TRAVELED IN ALL STATES (INCLUDING CANADIAN PROVINCES) 272 TOTAL GALLONS OF FUEL USED IN ALL STATES (INCLUDING CANADIAN PROVINCES) 3[, 8 AVERAGE MILES PER GALLON (LINE 7 DIVIDED BY LINE 2) ROUND TO TWO DECIMAL PLACES (O.O~) MILES TRAVELED ON WASHINGTON PUBLIC ROADS. TOTAL GALLONS OF FUEL useD ON WASHINGTON PUBLIC ROADS (LINE 4 .DIVIDED BY LINE 3) ROUND TO THE NEAREST WHOLE GALLON. DEDUCTIONS (USE COMPUTA nON SCHEDULES ON REVERSE SIDE) GAl.LONS OF FUEL PURCHASED IN WASHINGTON SPECIAl. (A) FROM SERVICE STATION, KEYlOCK. OR OTHER FACILITIES FUEL TAX PAID DELIVERED INTO VEHICLE FUEL SUPPLY TANKS (B) TAX PAID WITHDRAWALS FROM YOUR OWN BULK STORAGE. 272 34 o o 7. GALLONS OF FUEL USED IN MOTOR VEHICLES EXEMPT FROM SPECIAL FUEL TAX - FROM SCHEDULE "A" GALLONS OF FUEL useD TO OPERATE POWER PUMPING UNITS OR POWER TAKE-OFF EOUIPMENT, I"'J ON DELIVERY 1RUC~S PUMPING PROP"NE:, Fun OILS. 0" HEA7IN'l OILS, OR lofEASURED BY "'ETI'R/IO(J O'VICE APPROVED 81' THE OEPT .HIO'" SCHfDULE "B IBI ON CEUiNT ""111'/15 AND lOAO COMPACTOR GAR8AGE TRUC/(S.FROM SCIIEOULE .C" TOTAL GALLONS DEDUCTIBLE (ADD LINES S THROUGH 8) NET TAXABLE GALLONS TOTAL GALLONS ON WHICH TAX (OR CREDIT) IS DUE (SUBTRACT LINE 9 FROM LINE 51 IF LINE 9 IS GREATER THAN LINE 5, INDICATE CREDIT BY PARENTHESES. 3/+ COMPUTATION OF TAX DUE TAX DUE FOR REPORTING PERIOD TAX DUE (OR CREDIT) ( . l 3 e PER GALLON ON GALLONS SHOWN ON LINE 10) INDICA TE CREDIT BY PARENTHESES. PENAL TV FOR FILING AFTER 25TH OF MONTH (10 PERCENT OF LINE 11) .,], COLLARS 3 7/, 13. INTEREST FOR FILING AFTER 25TH OF MONTH II PERCENT OF LINE tli 14. TOTAL DUE (OR CREDIT) FDA REPORTING PERIOD (ADO LINES" THROUGH 13) INDICATE CREDIT BY PARENTHESES TAX ADJUSTMENT FROM PRIOR REPORTS 15. TAX ASSESSMENTS (OR TAX CREDITS) FROM PREVIOUS MONTH IS'. INDICA TE CREDIT BV PARENTHESES. 16. NET AMOUNT OF TAX (OR CREDIT) DUE, (LINE" AND IS). 'INDICATE CREDIT BV PARENTHESES. MAKE REMITTANCE PAYABLE TO STATE TREASURER. (NOTE MAILING INSTRUCTIONS ON REVERSE SIDE) 1 7/, 3 71. I I i . i I 'RCFUND OF It. TAX CREDIT ON LINE 16 M4Y BE CLA.IMEO ON THIS REPORT IN LIEU OF fiLING A. CLA.IM FOR REFUND o CHECK BOX IF YOU WISH TO APPLV FOR REFUND OF OUTSTANDING TAX CREDIT AT THIS TIME. t Cl''''''' UNDU TH. HNAUIU 0' HiltlV"" THA' 'HII "I!..o"T, INCLUDINO AN" ACCOMPAN'f'INO ICHI!DULI!I Oilt IUTU'!NTI. II TO TH( .I!IT 0' MY IeNOWLIDO! '''UI, CO.iltl~ COWPLITt. .-;;; /-U.......... (/, {ju.b...; "'CO Dirc.etnr, D~pt. nf Puhlie t~n"l':A :'~=::~::'tO~tt5=3S'OS--- p~(PAn(O AT Port TOWTlO"nd. W^ I"'tg3M~ [)An; l/S/ ,v.l:L ........ :' :'. :~;'i~to/.,." '" , """,. . '. .,,:, ::. ::. ::"':". ,. .',."" . "'~.' .,," . ". . .. ; ".:' . " ',', , , "':..",.': , .:' " .' : ' '.' " :':::' :'.;, " ,',.",.,', ,'. ':0, ".' ,; " , )~z~~ . :~~~~~~ , ~~i~}!11!r ;,": :, ' ': .".' '. "'. 1~~~t~i , .:: ", , "",,.';' : ,';: .',,' " ;,..i,;'," .. .;.... ,'" \. '.:: .' . 1,'... " ~ ,'I" .,.' ...... " ,. .. DEDUCTION DETAILS .. !If MORE SPACF. IS NEE.DED. ATTACH SEPA.RATE SHEETSI SCHED~LE A _Gallons used on Washington public roads in motor vehicles exempt by-statute from special fuel lax. (see Instruction sheel), ClaIm crealt Tor gallons 0 spediflUe us-ed on Washington public roads while operallng: ~~l ~~I~~b~~~~~~SS~~~~lg~o~:~:~r o~:~u~a~~~~nbed route within a 25 mile radius of corporate county limits. VEkICLEOR fLEeT NUI.IBER TOTAl.. OALLONS DE1.IVERED INTOVEH!CLES GALLONS USED ON WASHINGTON PU61..IC ROADS ----------------- . .... , . . . . . "':'---:~-"':",---:---"":':""':'- :, .' , --------------~-- , . .. : CARRY TOTAL, ROUNOEO TO NEAREST WHOLE GALLON, TO LINE 7 TOTAL GALLONS -+ " . \l'EI-IICll!: OH flEET NUIolBER TOTIl,L GALLONS PU~PEO . ~.. '.".', ----------- -------------------- ..,....',.. ,. ----------- -------------------- ~~~~--~---- -------------------- (.00075) ----------- ----(.00075)---- ----------- ----(.oooni'---- ----------- ----'(.0'0075'---- ----------- ----(.OOO~)---- ----------- ---~(.OOO~)---- ----------- ----(.~n)---- ----------- ----i~7~---- TOTAL GALLONS -+ ,: -~~-~"~~c~-- -------------------- ----------------~~-- CARRY TOTAL. ROUNOEO TO NEAREST WHOLE GALLON, TO LINE 8 (A), GALLONS SUBJECT TO CREDIT DIESEl.. OTHER ':7'-.:.....:.'i..--.;.':..' ======== QALLO"l$ SUBJECT TO CREDIT -DIESEL.. ,_ OTHER ',I' -------~ _,~--u-- . .:'>:: ". ',' .' ~CH~-OULE" c- Gallons ulled In ~allhlngt.?n to operals a power take-olt unll on cement mixer truck. and load compactors on garbage truck," (aee.lnslr~cUo'n .'. .. ... .':""' sheet) (100%) ====j~~~[==== ======== (100%) ----(100%)---- .-------- -:----c1ocw.).7,--,~ ,.-'~ t' ';','/, -;--- -(1ooiiu)---- -----(100%)---- -------- -----~~%)---- -------- : Gallons used In Washington to operate power pumping units or power take-of! equipment (a) on de,livery trucks 'pumplng propane,' SCHEDULE B. c's~e~ ~~~r~~lr:~t~~~e~:~s or (b) for other purposes if motor vehicle Is equIpped wilh a metering device approved by the department.. . . Claim credlt for three.fourths of a gallon for each 1000 gallons pumped. . Exam"ple:" (140,000 x .00075 r 105 credit gal,lons) Claim credit for 25% of the gallons .of special tuel used In WashIngton, Example: (3000 gallons lC .25 .... 750 crodl! pallons) i ....., ,e,' VllH'ClIEOIII 'UIT,NVtolIlER M.~tS TAAlltLED IN WASHINQTON I~A~~~~~N~~~~ TOT..... OALlON'j OUlVEREO IN'TOV1!HICl[S (.25) ----------- ----------------- ----------------- ----------------- -----~i5)----- ----------- ----------------- ----------------- ----------------- -----~i5)----- ----------- ----------------- ----------------- ----------------- -----~.5)----- ----------- ----------------- ----------------- ----------------- -----~i5)----- ----------- ----------------- ----------------- ----------------- -----~i~----- ----------- ----------------- ----------------- ----------------- ----~~.~----- ----------- ----------------- ----------------- ----------------- -----~i~----- CARR~ TOTAL. ROUNDED TO NEAREST WHOLE GALLON, TO LINE B, (9) TOTAL, GALLONS_ OAllONS SUBJECt to CREOtT OIESEL ... ,OTHER /, F.le ttll. r.pOf1 .nd ,....tn.ne. "'.1" ttte Stile 01 W""lngton, Oflp.'1mfln' 01 Molor !Jehter"., Fuel r._ DivlI'on, POBOX 22~8, Olympia, W..hl"Olon 9BMl4. PENA.LtlES ReporIl.,. OUI on or bololl I~ 2!ilh day nl It,lt month 101l0wHlg Ule ^ G"lrgo 01 10 percenl plus I"Iflrelt lit 1'" 'lie 01 I porconl per monlh of Ihe 1.11 dult .....11 be ...."M'<I 'or 1.1. ntportll DlrK1 InQ\m'ot 10 l'lt' FII"I TIIII OI'/I,I('l" or Telephone {tOOl 75,3-6000 D'STR'DUTlON OmGINAL: To Depat1monl of MOlor V~llIcles OUrl-leA TE: Spec,.1 fuel use", cop.,. ~.... . - ~ r}5iJ{\~~r I.: ! J , ~, , f L , i to' ! f ! I .'. ; . ( .. l: !, AVOID : '\'" >:. , . .~ FT-441-112 IA 11-76) DUPLICATE S~IAL FUEL USER'S TAX REPORT STAlE OF WASHINQlON_OEPAATMENl OF MOTOR VEHIClES . FUEL TAX DIVISION P.O. BOX 2228 OLYMPIA, WASHINGTON 98504 FlAM NAME . I ~ ,';' f ,,~, ~:: ' ',1 , i, 1 SPECIAL FUEL LICENSE NO. ..t-,: .~ ('! :.. f h ';;"' i '~Vi, '::,;";1 REPORTING PEAIOD.MONTH November, 19..1....1.- D NO OPERATIONS DURING ,MONTH o ~H,1~Hlt~J~/J~A~A~J~p~~lN- .p~~(~;~.g~gi IN D LICENSE IS RETURNED FOR CANCEL~ATION NO. OF VEHICLES OPERATED INTO AND/OR IN WASHINGTON MAILING ADDRESS '.. ' .~ ;.~:) u ~-:' CITY. STATE, & ZIP ~""".CHIo""'l"'''''''(, ..DD~f.r.50"O_l~J;rII" ....el,."iClOlHQ~l_T USE SPECIAL FUEL INSTRUCTION SHEET AS A GUIDE WHILE COMPLETING THIS FORM COMPUTATION OF TAXABLE GALLONS (SHOW SEPARATE MILES AND GALLONS FOR OIESEL FROM OTHER SPECIAL FUELS) ".; DIESEL,;: 1. MILES TRAVELED IN ALL STATES (INCLUDING CANADIAN PROVINCES) TOTAL GALLONS OF FUEL USED IN ALL STATES (INCLUDING CANADIAN PROVINCES) ;3. AVERAGE MILES PER GALLON (LINE 1 DIVIDED BY LINE 2) ROUND TO TWO DECIMAL PLACES (0.00) MILES TRAVELED ON WASHINGTON PUBLIC ROADS. TOTAL GALLONS OF FUEL USED ON WASHINGTON PUBLIC ROADS (LINE 4 DIVIDED BY LINE 3) ROUND TO THE NEAReST WHOLE GALLON. OEDUCTIONS (USE COMPUTA TlON SCHEDULES ON REVERSE SIDE) GALLONS OF FUEL PURCHASED IN WASHINGTON SPECIAL (A) FROM SERVICE STATION. KEYLOCK. OR OTHER FACILITIES FUEL TAX P"'O DELIVERED INTO VEHICLE FUEL SUPPLY TANKS (BI TAX PAID WITHDRAWALS FROM YOUR OWN BULK STORAGE. 7. GALLONS OF FUEL USED IN MOTOR VEHICLES EXEMPT FRO". SPECIAL FUEL TAX - FROM SCHEDULE "A" GALLONS OF FUEL USED TO OPERATE POWER PUMPING UNITS OR POWER TAKE-OFF EOUIPMENT IAI ON DELIVERY TRUel(!; PUMPING PROPANE. Fun OILS, Of! HE"'Tmo OILS, OR ME"'SUf!ED B1 MFrfRI"IO DEVICE APPROVED BY tHE DEPT,.FROM SCHEDULE -S rSI 0"1 CEMENT MillERS AND lOAD COMPACTOR GARBAGE TRUCf(S.FROM SCHEDULE 'C' TOTAL GALLONS DEDUCTIBLE (ADD LINES 8 THROUGH 8) NET TAXABLE GALLONS TOTAL GALLONS ON WHICH TAX (OR CREDIT) IS DUE (SUBTRACT LINE 9 FROM LINE 5J IF LINE 9 IS GREATER THAN LINE 5, INDICATE CREDIT BY PARENTf-tESES. COMPUTATION OF TAX DUE TAX DUE FOR REPORTING PERIOD TAX DUE (OR,CRED1T)( '~-. 1.1 e PER GALLON ON GALLONS SHOWN ON LINE 10) INDICATE CREDIT BY PARENTHESES, PENALTY FOR FILING AFTER 25TH OF MONTH 110 PERCENT OF LINE 1IJ 2 31 INTEREST FOR FILING AFTER 25TH OF MONTH " PERCENT OF LINE 11) TOTAL DUE (OR CREDIT) FOR REPORTING PERIOD (ADO LINES 11 THROUGH 13J INDICATE CREDIT BY PARENTHESES, TAX ADJUSTMENT FROM PRIOR REPORTS 2 31 TAX ASSESSMENTS (OR TAX CREDITS) FROM PREVIOUS MONTHIS). INDICA TE CREDIT BY PARENTHESES, o CHECK BOX IF YOU WISH TO APPLY FOR REFUND OF OUTSTANDING TAX CREDIT AT THIS TIME I ~ ~ I CIE"Tl" UNOf" l't4f HNI.L flU 0' """,1U"V TH.U THII "t;'O"T, INCLUDINQ ANV ACCOMPANVING ICHI!DULU 0'1 ITAnUIN", 11 TO Tt041 InT 0' MV IeNOWLIOQI ~ '''UI, COfll"l~ COW\.ITl. _ ~ i5 X =;,(((:"1''- C /V<..,.(,.,./ "Tl< Dirpctor, D<,pt. of Puhlic liorl'o ~ SIOIllUURE J,.,d-_i,)[J; !lU"ioINESS pwO"lr . (-Arr'A-Am A.T Port TO~"'RAnn I H^ ()01(,n DATE n",.. f) 1?+.-- I 'AHUNO OF AlA. entoll ON LINE HI MAV BE CLAIMf.O ON THIS REPORT IN LIEU or: FILING A CLAIM FOR REFUND NET AMOUNT OF TAX (OR CREDIT) DUE. (LINE l<AND 15). 'INDICATE CREOIT BY PARENTHESES. MAKE REMITTANCE PAVABLE TO STATE TREASURER ~ (NOTE MAILING INSTRUCTIONS ON REVERSE SIDE). 2 31 .. . DEDUCTION DETAILS tit (IF MORE SPACE IS NEEDED. ATTACH SEPARATE SHEETSl.... SCHEDULE A. -~:~Oi~~t~~~~o~n S~~~~.ington public roads in motor vehicles exempt by statute from special fuel tax. la m ere It or ga ons 0 special ue used on Washington public roads while operating: (A) Molor vehlcle~ using propane or natural gas. (S, An urban transjJortation system over a prescntled route witf1fn a 2S mile radius of corporate county limits. VEI-IICLEOR FLEET NUM8EFI TOTAL G....LLONS DELIVERED INTOVEI1IClE$ G....lLONS USED ON W....sH'NorON PUBLIC RO....DS GALLONS SUBJECT TO CREDIT CARRY TOTAL. ROUNDED TO NEAREST WHOLE GALLON, TO LINE 7 (100%) -----(1000/.)---- -----(1ooo/,) ---- -----(,000/,)---- .-------- -----(1000/,)---- -----(100%)---- - - ---(100%)---- -----(100%)---- TOTAL GALLONS Ga!IOns used In Washington to operate power pumping units or power. take-oft equipment (a) on de.livery trucks pumping propane, SCHEDULE B. fuel oils or heating oils or (b) for other purposes if molor vehicle is equipped with a metering device approved by the department. (see instruction sheet. Claim credit for three-fourths of a gallon for each 1000 gallons pumped. Example:" (140,000 x .00075 = 105 credit gallons) VEHICLE OR FLEET NUMBEfl DELIVERY METe! REAOINGS TOTAL GALLONS PUMPEO aAu.ONS SUBJECT TO CREOIT (.00075) - - - - (.00'075) - - -- ----{:00(75)---- ----{:00(75)---- --- -(.Do'075)---- ----'(,00075)---- ----(',00075) ---- ---7('000'075)---- TOTAL GALLONS -+- (see Instruction MILUTRAVHl!O I'" WASHlNOlON GALLONS USEe IN WASlilNorON RArE' OAllONS SUDJEcr TO CAEOlr orHEA ----------------- ----------------- ----------------- (.25) -----i..5' ----- -- - -- i..., -- --- -- - -- i.i.,- -- -- -n--i...'----- -- ---i,." -- --- -----i...,--n- --- --i..."j----- TOTAL GALLONS ----------------- ----------------- ----------------- ----------------- ----------------- ----------------- ----------------- ----------------- ----------------- CARRY TOTAL, ROUNDED TO NEAREST WHOLE GALLON. TO LINE 8, (8) Fl'. nlll I~rt .1'Id Nml".~ ....,lI\ the St.le 01 W.~hl1lglon, Ottpartmenl of MolD' Vflhlelel, FUfll T,.. Olvillon, PO. ROX 2228, Olvmpla, W..hington 98504 AVOIO PENAL TIES' Report. arf alA on t)t before I'" 2511'1 ajV' 01 Ihfl montrl tOllOWI"g UN. /II, en.rge of 10 percenl pllol. Inlere.l II Ih. rile 01 t poreenl per monlh of th. 1111 dlMl WIll b.- .....Md 'or 'It. tl'lportl O'UI(';I InqUlMI 10 11'10 ruel Tu Oiv.,lon or Tflll'lphonfl "061 753...f1900 O,STRIDUTlON: ORIGINAL: To O&paf1ment of Motor Vahlel..s OUPLICA TE. Special tutU us",'s copy : SpeCIAL FUEL LICENSE NO. REPORTING PERIOD-MONTH Sep tember D NO OPERATIONS DURING MONTH o JJ1~~~t~~~t(!l~/1iA~ll~NN~ ,9~~{~~f>~ IN. o LICENSE IS RETURNED FOR CANCELLATION NO. OF VEHICLES OPERATED INTO AND/OR IN WASHINGTON . . ; . ~""""'. .... ............. :" ; .' . .: : . . .... . .' . ..' . .' : . . ',." . . I ,,' .': . FT-441-112 (R 11-16) DUPLICATE SP.AL FUEL USER'S TAX REPORT STATE OF WASHINGTON--OEPARTMENT OF MOTOR VI::HICLES .. FIRM NAME MAILING ADDRESS . :\ CITV, STATE, & ZIP SHO........fCH.f<<lf.'.......E.. .QOolUSOM O.......IlSHl. "loCi f'fl~(;Ul'ooa ~IPOllT FUEL TAX DIVISION P.O. BOX 2228 OLYMPIA, WASHINGTON 98504 ..-.:-:: ... - :,'. ..,'....> : '.:, :". . . ". .... '. .'. '. "..' .....:. . '. '" ~. . ,: . .... ;. .' .:~:' .., '.' ......: L'" " '. , : ...; , .... :;. " .,.... [~~f;~ . .:' . 77 19_ .~~-,~~"..._.,'~-, ~'''''''N'''''__~''~'''_'~__'_n.'..._ .".._"....~."'..,._.,,~_~..... -.~::t.~..1;S~:~~);> ~j'.,,~ ;,.':j:,-'.,.<::....,;;.r~','.',.."-! . ,-.'I:'ll.':'jlk.... 'COMPUTATION OF TAXABLE GALLONS ':-.'_''-':-',.i::.: :.,,":: ,:':,DIESEL' [=]'.OTHER~: GALLONSSU,~jEC::TTOTA)(:-(SHOWSEPARATE MILES AND GALLONS FOR DIESEL FROM OTHER SPECIA~FUELS) 1. MILES TRAVELED IN ALL STATES (INCLUDING CANADIAN PROVINCES) I eUlT"Y UNDU THt HN~nfl 0' ""Wilt., TH" TH'I "rpOIltT,INCLUOINQ ANY ACCOMPANYING ICHI!DULlI 0.. ITAnuINr.... TO THI! 'IIT 0' UY kNOWUDOI TlIIur. eO"..eer ANO eOM"-ITI. r.::-/' /."":'"f. ..../ Director, O"l't. of Public Workn liiIG~ATURE)( I~ t""I..({,,"t_~ c" /.J<- ~. TITlE RUJINf.SS PHO,.[ -3tl5-3-S05- __ ""f.PAnr.o AT ~1ft!nd-;-WA 2. TOTAL GALLONS OF FUEL USED IN ALL STATES (INCLUDING CANADIAN PROVINCES) 3. AVERAGE MILES PER GALLON (LINE 1 DIVIDED BY LINE 2) ROUND TO TWO DECIMAL PLACES (0.00) 4. MILES TRAVELED ON WASHINGTON PUBLIC ROADS. 5: TOTAL GALLONS OF FUEL USED ON WASHINGTON PUBLIC ROADS (LINE 4 DIVIDED BY LINE 3) ROUND TO THE NEAREST WHOLE GALLON. I.' '.: .... DEDUCTIONS (USE COMPUTATION SCHEDULES ON REVERSE SlOE) 6. GALLONS OF FUEL PURCHASED 'N WASHINGTON SPECIAL IA) FROM SERVICE STATION. KEYLOCK, OR OTHER FACILITIES FUEL TAX PAID OELIVERED INTO VEHICLE FUEL SUPPLY TANKS. IB) TAX PAID WITHDRAWALS FROM YOUR OWN BULK STORAGE. 7. GALLONS OF FUEL US EO IN MOTOR VEHICLES EXEMPT FROM SPECIAL FUEL TAX _ FROM SCHEDULE "A" 8. ~~~~:: ~~I;~~RU:~~ETROT~:~~;; :g;::ENT. 1/"'1 ON DnIVf"~ '''UCIIS PUMPING PROPANE. FUrL OILS. Olf HEArING OILS. OR MEASURE'O S~ I ME,nmvG DEVICE APPROVED B~ rHf OEP'AROM SCHEDULE _1'1 IS} ON CEMENT MIXERS AND LOAO COMPAcrOR OARS"'OE rRUCKS.F~OM SCHEDULE 'C' 9. TOTAL GALLONS DEDUCTIBLE (ADD LINES e THROUGH 8) NET TAXABLE GALLONS 10, '.TOTAL GALLONS ON WHICH TAX (OR CREDIT) IS DUE (SUBTRACT LINE 9 FROM LINE 5) IF LINE 9 IS GREATER THAN LINE 5. INDICATE CREDIT BY PARENTHESES. ..' '::~ CDMPUTATION OF TAX DUE ,. "".'. 0.' ',,,., " ..,.., ",C;;;-.,:, . TAX DUE FOR REPORTING PERIOD 11, TAX CUE (OR CREDIT)( . , ; e PER GALLON ON GALLONS SHOWN ON LINE 10) INDICATE CREDlr BY PARENTHESES, 12, PENALTY FOR FILING AFTER 25TH OF MONTH "0 PERCENT OF LINE ") 13, INTEREST FOR FILING AFTER 25TH OF MONTH (I PERCENT DF LINE ") 14, TOTAL DUE (OR CREDIT) FOR REPORTING PERIOD IADO LINES" THROUGH 13) INDICATE CREDIT BY PARENTHESES. TAX ADJUSTMENT FROM PRIOR REPORTS 15, TAX ASSESSMENTS (OR TAX CREDITS) FROM PREVIOUS MONTHIS), INDICA TE CREDIT BY PARENTHESES. '6. NET AMOUNT OF TAX lOR CREDIT) DUE, (LINE,. AND IS). 'INDICATE CREDIT BY PARENTHESES, MAKE REMITTANCE PAYABLE TO STATE TREASURER. (NOTE MAILING INSTRUCTIONS ON REVERSE SIDE , ,,':: 'RnUND or- A TAX CREDIT ON LINE 18 UAV BE CLAIMED ON THIS REPORT IN LIEU OF FILINQ A CLAIM FOR REFUND CJ CHECK BOX IF YOU WISH TO APPLY FOR REFUND OF OUTSTANDING TAX CREDIT AT THIS TIME ~8J~e DAlE OC&. 6, 1977 "'- ',',' ., ',' ;r:., "'- "--'., '.' , """::" :.':, .'. :' . i:,~,' " '. . .'j.:' '. '. 'o, --, (OIESEL Ot-!LVJ D,PfIIl~."~ D.....'V~.lClO.I. . 936 . 117 .. Il -. . 936 117 . I. 0 0 I. 0 0 0 . O' >'t' 117 . ,,:',:',:,;:.,w;./:~,: T ,i(";/' DOlLAAS CENTS 12 87 12.87 I I i ! 10_! 12 87 ..: .., ::. :'. '. ,...,::' '."".. :',: ..... ,,' I ,: .l" : . . '. "'... ';". ,....; ,"; :','.' . .', .... ':-,.; "". ;, . ':'" ,: . .,'....: :', " -"" . ';" . ".~.:.;~,: ..J '. . '. :., , '':' " .- ...... . DEDUCTION DETAILS" (If MORE SPACE IS NEEOED, ATTACH SEPARATE SHEETS. . SCHEDULE A _Gallons use~ on Washington public roads in motor vehicles exempt by statute from special fuel lalC, (see Instruction sheet). Cia m ere It or ga ons 0 specls fuel used on Washington public roads while operating: . tAl Motor vehicles using propane or natural gas. IS) An urban transportation system over a prescribed route within a 25 mile radius of corporate county limits, FlVlE';!c;.~M~~R . GALLONS USE(] ON W"SHINGTQN PUBLIC ROADS .TOTAl GALLONS DELIVERED INTO VEHICLES ----------- -:.-::."'7 ~,~.---..:...;.~. .," : ., . ----------------- . .,' .., - CARRV TOTAL,. ROUNDED' TO NEAREST WHOLE GALLON, TO LINE 7 (100'0/0) =====(!~~[==== (10D%) -----(1OCWo'- --- ='~==~~€~oI==== " . (100%) -- ---(1000/.)"---- -----(1000;.)"---- TOTAL GALLONS .' ".0, Gallons used In Washington to operate power pumping units or power take-olf equ pment (a) on de.livery trucks pumping propane, SCHEDULE B. fuel oils or heating oils or (b) lor other purposes If motor vehIcle Is equipped with a metering device approved by the department. . (see Instruction sheet. Claim credit for three-fourths of a gallon for each 1000 gallons pumped. Example: (140,000 x ,00075'= 105 credit gallons) VEtilCI..EOR FLEET NUMBER TOTAL GALLONS PUMPED ...... , (.00075) ----(.00075)---- ----.(.00075)---- ----(.00075)---- ----(.00075)---- --- -'(.00075)---- --- -('.00'075)---- ----'i.aoolsj---- ...... FT-441.1l2 (R 11-76) DUPLICATE SF8AL FUEL USER'S TAX REPORT STATE O~ WAStjlfIIOTON_DEPAIlTMENT O~ MOTOR VEHICLES .. DIESEL';: ':O:'OTHER;"'; '" FIRM NAME SPECIAL FUEL LICENSE NO. MAILING AODRESS REPOATlNG PERIOD.MONTH Augus t 31, D NO OPERATIONS DURING MONTH o ~~~Hllt~!6~lRA~W~~lN. .pJAE~I~~.pM IN o LICENSE IS RETURNED FOR CANCELLATION NO. OF VEHICLES OPERATED INTO AND/OR IN WASHINGTON CITV. STATE. & ZIP 6HQw,,~y C>M~GI'" .......E. ..DQAt..OAow..e......'p .,..cIlPOlf.ClDlIoQ"fPOllJ .~~_U~-...-3..~_.,'.~.....~....'_~'.3..~..._._......._ ..,..........;-....~......._.'.._3....' . .", COMPUTATION OF TAXABLE GALLONS 'GALLONS.SUSJECTTO T~X-'(SHOW SEPARA TE MILES AND GALLONS FOR DIESEL FROM OTHER SPECIAL 'FUELS) (DIESEL ONL V) D""op....t. D.....TUII...au 1. MILES TRAVELED IN ALL STATES (INCLUDING CANADIAN PROVINCES) 12Ml 2. TOTAL GALLONS OF FUEL USED IN ALL STATES (INCLUDING CANADIAN PROVINCES) 156 AVERAGE MILES PEA GALLON (LINE 1 DIVIDED BY LINE 2) ROUND TO TWO DECIMAL PLACES (0.00) MILES TRAVELED ON WASHINGTON PUBLIC ROADS. TOTAL GALLONS OF FUEL USED ON WASHINGTON PUBLIC ROADS (LINE 4 DIVIDED BY LINE 3) ROUND TO THE NEAREST WHOLE GALLON. DEDUCTIONS (USE COMPUTA nON SCHEDULES ON REVERSE SIDE) GALLONS OF FUEL PURCHASED IN WASHINGTON SPECIAL {AJ FROM SERVICE STATION. KEVLOCK. OR OTHER FACILITIES FUEL TAX PAID OELIVERED INTO VEHICLE FUEL SUPPLY TAt,jKS (8) TAX PAID WITHDRAWALS FROM YOUR OWN BULK STORAGE. GALLONS OF FUEL USED IN MOTOR VEHICLES EXEMPT FROM SPECIAL FUEL TAX _ FROM SCHEDULE "A" GALLONS OF FUEL USED TO OPERATE POWER PUMPING UNITS OR POWER TAKE-OFF EQUIPMENT. (AI O~ PCLIVE"r rRUCIIS PUMPINO PROP"'~E. fun OILS, 0" HEATING OILS. 0" MEASURED or UFrrR!~a DEVICE "'PPRDVED or THE DEPT.FROU SCHEDULE "S'" fB! ON CCIJENf MI:rERS A~D LOAO COMPACTOR ClARBoilOE TRUCKS.FROM SCHEDULE .C. o TOTAL GALLONS DEDUCTIBLE (ADD LINES' THROUGH 8) o NET TAXABLE GALLONS TOTAL GALLONS ON WHICH TAX lOR CREDIT) IS DUE (SUBTRACT LINE 9 FROM LINE 5/ IF LINE 9 IS GREATER THAN LINE 5. INDICATE CREDIT BY PARENTHESES. 156 ';:i COMPUTATION OF TAX DUE 100 DOLLARS CENTS TAX DUE FOR REPORTlN TAX DUE (OR CREDIT) ( . ' BY PARENTHESES. PENALTY FOR FILING AFTER 25TH OF MONTH (10 PERCENT OF LINE 11) ~ PER GALLON ON GALLONS SHOWN ON LINE 10) INDICATE CREDIT JA 01, INTEREST FOR FILING AFTER 25TH OF MONTH (1 PERCENT OF LINE 11) TOTAL DUE (OR CREDIT) FOR REPORTING PERIOD (ADD LINES 11 THROUGH 13) INDICA TE CREDIT BV PARENTHESES. TAX ADJUSTMENT FROM PRIOR REPORTS TAX ASSESSMENTS (OR TAX CREDITS) FROM PREVIOUS MONTHIS). INDICATE CREDIT BV PARENTHESES. NET AMOUNT OF TAX (OR CREDIT) OUE, (LINE,. AND IS). 'INDICATE CREDIT BV PARENTHESES. MAKE REMITTANCE PAVABLE TO STATE TREASURER - NOTE MAILING INSTRUCTIONS ON REVERSE SIDE S H 04 I', 04 o CHECK BOX IF you WISH TO APPLY FOR REFUND OF OUTSTANDING TAX CREDIT AT THIS TIME. 'REFUND OF A TAX CREOI' ON LINe 16 MAY BE CLAIMED ON THIS REPORT IN LIEU OF FILING A CtAIM FOR REFUND ."./?~ . J4~"':1,~;7,; I n"n,y UNOIt:" ftoIr ""AU". 0' ""JUlIlY 'f"HAT TNI' IIr.-o..,. INCLUDINO ANY ACCO"''&'''YINQ ICHrOULII 0" aTATIWI!NTa. " '0 THI ."T 0' MY ICNOWUDOI! TMII. CO""'CT ANDh~UTl. ...- A ~ nireetor. Dept. of Public Works IIQN4TUR[ X .-t.-..-.~c,",~ /~ ----........ TITtE 8lJ9IN1.:S8 PHONt 31)5-3505 rnC"AAfO AT Port TO"'l.fUIDd. t~^ t)H 1'tA DAn S"p" Rl "22- A,I,T( GALLONS SU8JECT TO CREDIT . DEDUCTION DETAILS. (IF MORE SPACE IS NEEDED. ATTACH SEPARATE SHEElSI SCHEDULE A _Gallons use~ on Washington public roads In motor vehicles exempt by statute from special fuel tax. (see Instruction sheet). Cia m cre It or g8 ons 0 specla ue used on Was mglon public roads while operating: '(AJ Motor vehicres using propane or nalural gas. (8) An urban transportation system over.8 prescribed route within a 25 mile radius 01 corporate county limits. VEHICLE OR fLEET NUMBER TOlAL GALLONS DHIVEREO INTOVEI-1IClES WASH~~~\~~S ~~~~c O~OAOS ____J!O~~L____ (100%) -----(100%)---- ---- -(1000/0)'---- ===='=~€o~I==== _____(!~~oL____ _____~~!_L____ (100"lcl) CARRY TOTAL. ROUNDED TO NEAREST WHOLE GALLON. TO LINE 7 TOTAL GALLONS Gallons used in Washington to operate power pumping units or power take-of! equipment (a) on deJlvery trucks pumping propane, SCHEDULE B. fuel oils or heating oils IJr (b) for,other purposes if molor vehicle is equipped with a metering device approved by the department. (see instruction sheel). Claim credit for three-fourths of a gallon for each 1000 gallons pumped. . Example: (140,000 x J)OQ7S :: 105 credit gallons) VtHlClEOR flEET NUM8ER TOT~~:::i~ONS (.00075) ----(.ciojj75)~--- ----(.000-75)---- ----(.00075)'---- ----'(.00075)'---- ----('.00075)'---- ----('.00'075)'---- ----'(.OO075}- --- TOTAL GALLONS_ . :'SCHEDUlE C..- ::I~I used In Washington to operate I!I power taka-oU unit on cament mixer Irucks and load compactors on garbage Iruck.s. (see Instructlon . TOUl.. l'l"","LONS DELIY[RED l~rOVEI1ICU.s MILES TRAVELED IN WASHINGTON I~A~~~~~~~~~ GALLONS SUaJCCT TO CREDIT OlESEl.. CARRY TOTAL, ROUNDED TO NEAREST WHOLE GALLON, TO LINE 8, (8) (,") -----i,i,1 ----- -----i,i,ln--- -- ---i,i,'j -- --- -u--i,i,'j-nu -- - -- i,i,j -- - n -----i,i'I"---- -----i,i,'j-.---- TOTAL GALLONS f'1~ 1"11 r.pot'l aftd ,....".lane. WIt" thoi' Sulte of Wa.hlnglon, Dol'lartmenl 01 Molo, Vehicle.. Fuel fa. Dlvi.ion, PO, 80)( 2228, Ofympi.. Wllhinglon 98500... AVOID PENAL liES, Reporlt arfl IJ.,. 01'\ or belOIt ltoe ~$Ih d.y 0' the rnonlh follOWing UH Ii. cna,ge 01 10 l'IOrccml ptu. Inlllrell 11 tho fa III 01 I pefellnl per monlh ,01 11'1. 111M cJlJII .iII bet ..,nWd lor la'e '.pa"', o.lKt InQuJrlll' 10 I"" ruel TI. 01'11.10'1 or TlOlephr;me (200) 150:1-6900 DISTRIDUTlON: ORIGINAL; To OePlir1lMnt of Malar VflhlCles OUPLICA TE: Special fuel uu,', copy .~:".::, ):,':-::':'::_:.:~,":,:':,;:,.>,i,:;::':,:: ,"j~~~j,f.\~1l~iarrlW~~{'llS~~_~i~.~~{:I"i~I,t~:,~{\;i "',~:',:"..,'.,,"',,..,"','-,<':.,.,.-' ..-,,',,','. ",', " "',""", ., ',' "' ,,,' J ~:':>::,.,:'V::i:.;,~::~;;:',:,; '",";\ ",< ' "",, '! :,r .'1 ' .'.':;1.';', ".:,"!,",; ,:";':,';'. .. Fi....41-112. fR 11-761 DUPlICA TE SP4L FUEL USER'S TAX REPORT StATE Of WA,SHINGTON-DEPARTMENT OF MorOA VEHICUS 23 94 8 FUEL TAX DIVISION P.O. BOX 2228 OLYMPIA, WASHINGTON 98504 \ MAILING ADDRESS SPECIAL FUEL liCENSE NO. USE SPECIAL FUEL . ':"""::;'<':';::;." - "-. '-. ".;' ,,,..:..,,,..:: -', "-"" '. ,-' -' , ","' - . " , -" ,'. ". ..GALLON~..S~~JEC::T.TOTAX_(SH6W SEPARA TE MILES AND GALLONS FOR DIESKFRDM OTHER SPECIAL FUELS);: :1. MILES TRAVELED IN ALL STATES (INCLUDING CANADIAN PROVINCES) , ;'::~ ,(" AVE~AGE'MILES PER GALLON (LINE 1 DIVIDED BY LINE 2) ROUND TO TWO DECIMAL PLACES (0.00) TOTAL GALLONS OF FUEL USED IN ALL,STATES (INCLUDING CANADIAN PROVINCES) 4. MilES TRAVELED ON WASHINGTON PUBLIC ROADS. TOTA,I.: G.~LLONS OF FUEL USED ON WASHINGTON PUBLIC ROADS (LINE" DIVIDED BY LINE 3) ROUND' TO THE, NEAREST WHOLE GALLON. ""':/.:-:::,;;','OEDUCTIONS (USE COMPUTATION SCHEDULES ON REVERSE SIDE) GALLONS OF,FUEL PURCHAseo IN WASHINGTON SPECIAL (AI FROM SERVIce STATION, KEYLOCK, OR OTHER FACILITIES FUEL'TAX PAID OELII/ER!:D IN~O VEHICLE FUEL. SUPPLY TANKS, IB) TAX PAlO WITHDRAWALS FAOM YOUR OWN BULK STORAGE. 7. GALLO.NS' OF FUEL USED IN MOTOR VEHICLES EXEMPT FROM SPECIAL FUEL TAX _ FROM SCHEDULE "A" GALLONS OF FUEL USED TO OPERATE POWER PUMPINQ"UNITS OR POWER T ME-OFF EQUIPMENT, t.-., ON onlVERY TRUClrS PUMPINO PROPANe. Fun OILS. OR HE.-.rI"IO OILS, OR MEASURED HY METERING DEVICE APPROVED SY T~E DEPT,.FROM SCHEDULE "S /S1 ON CEIJEItIT 1oI/J(ER$ A"ID LOAD COMPACTOR GAROAGF TRUCKS.FROM SCHEDULE .C. T<)TA'~,:G,~~lo'N~ DEDUCTIBLE (ADD LINES a THROUGH 8) NET. TAXABLE GALLONS TOTAL GALLONS. ON WHICH TAX (OR CREDIT) IS DUE (SUBTRACT LINE 9 FROM LINE 5) IF' L'INE 9 'IS GREATER THAN LINE 5, INDICATE CREDIT BY PARENTHESES. ~ '}'- ,,', -: CENTS PENALTY FOR FILING AFTER 25TH OF MONTH (10 PERCENT OF LINE 11) 23 94 INTEREST FOR FILING AFTER 25TH OF MONTH (I PERCENT OF LINE 11) TOTAL DUE (OR CREDIT) FOR REPORTING PERIOD (ADD LINES 11 THROUGH 13) INDICATE CREDIT BY PARENTHESES TAX ADJUSTMENT FROM PRIOR REPORTS TAX ASSESSMENTS (OR TAX CREDITS) FROM PREVIOUS MONTH(S). INDICATE CREDIT BY PARENTHESES. NET AMOUNT OF TAX (OR CREDIT) DUE, (LINE,. AND '5). 'INDICATE CREDIT BY PARENTHESES. MAKE REMITTANCE PAYABLE TO STATE TREASURER. NOTE MAILING INSTRUCTIONS ON REVERSE SIDE) 23 94 'REFUND OF A TAx CREDIT ON LINE 16 MAY BE CLAIMrO ON n'lIS REPORT IN LIEU OF FILING ^ CLAIM FOR REFUND. CJ CHECK BOX IF YOU WISH TO APPLY FOR REFUND OF OUTSTANDING TAX CREDIT AT THIS TIME. I c..,... UND.o TH. .iNALT'" 0' ,......, '.AT 'H"O'''''." INCLUD'N. .., .CCDM......D 'C.'DUL" DO "'''M''". "'D... .UT 0' M' "DW"D., nul, CettllllCT ANO CO~I. . . $I"..fU., X y~~?: ~-/..'-" "H.' Director, n..pt. of Public Works IlUsINES' '''0'' 385-3505 'O"A.,O AT Port To,,"send.~ WA 98368 O'T, August 4. ,,!I. 5.1'.2. ),~,r:, ,..J:l< 4..,. , ,~?: ->G ~ ~ ,:!9.:z(, ~ "'11 9..- & !)Xi. ! ~ ~ ,,' " , , '~, '" ; . . ,'. 'I,> . . '.,,'.' ' ,': ',,: . ,'. < ~,' """ .. ~ . '-' ,:,',.' .\ .,'" .. ,,'.,',.., , ',.'.',. ",' ,'" ";",,,,:.':.' _::: .\;:~., ;1 :t', , ','.,', .'. , " .' .'::, " ,,".. < '" , ' .' ,.",: , " '. ... DEDUCTION DETAILS. [IF MORE SPAce IS NEEDED. ATTA,CH SEPARATE SHEfoTS) SCHEDULE A -~:~ol~~t~:~o~ns~~~~.ingIOn public roads in motor vehicles exempt by statute from special fuel tax. Claim cr~a.'t or ga~rons 0 specIal Tue used on Washing Ion public roads while operating: (A) Molor vehicles using, propane or natural gas. (8) An urban transportation system over a preSCribed route within a 25 mile radius of corporate county limits. VEHICLEPR fLEET NUMBER TOtAL CALLONS DELIVERED INTO VEHICLES O"LlONS USED ON W"SHINGTON PUBLIC ROADS GALLONS SUBJECT TO CREDI' DIESEL OTHER ','" " ----------- . ' " , ----------------~ (100%) ----------------- -----(100%)---- -----~.-- ----------------- ----(1~%)---- -------- ----------------- ----(100%)---- .-------- ----------------- ------------- -------- '(100%) ----------------- ----(1~1)--~- -------- ----------------- -----~OO%)---- -------- ----------------- ----(100%)---- -------- TOTAL GALLONS _ CARRY TOTAL, ROUNDED TO NEAREST WHOLE GALLON, TO LINE 7 ... " " SCHEDULE B- ~:~:O~I:S u~~~~~lI';;';S~i,~g~~(~f 1~~e~~~:/~u~~~~e~~fi~~I~~I~~~~I~Oi;".:q~~~:J' :~~I~m~;,~!r~9 O~e~~~V~;;p~;;:'~~S tvU;r:,~I~~::~~a."n~: (see Instruction sheel). Claim credit for ,three~fourths of a gallon tor each 1000 gallons pumped. EXample: (140,000 x .00075 = 105 credit gallons) veHICLE OFt fLEET "'UI.4BER OELIVeRY UETEA REA,OINGS TOTAL CALLONS PUMPEO CAllONS SUBJECT TO CREDIT OIESEL OTHER CARRY TOT!,L, ROUNDED TO NEAREST WHOLE GALLON, TO LINE 8 (A). .;:.......,'. (.00075) - ---c:OOD7sj---- ----,,00'075)- --- ----,,00(75)---- ----(.00'075)---- ----('.00'075)-- -- ----'(.00075)- --- ----7.00075,---- TOTAL GALLONS -.. . "'-',,.:. """,' -,---------- "2."::.::;..;~__:..__ ----..,------ , "''''j' ".: > .' : S'CH'e'OULE :C. Oallon. used in Washington 10 operate a power lake-olf un II on cement mlxor trucks and load compactors on garbage truc:k,a. &heet) 'Claim credit tor 25% of Ihe gallons.of spoclar fuel used in Washington. Example; (3000 gallons x .25 '" 750 credit gallons) (see Instruction YrHlCLIEOIl 'un NUUetiR TOTAl,. GAUONS OnlVII'I[O If\lTOVEH'c.a.E5 ""Illli TRAVELEO l""WA'5HINaT~ i, OAlLONSUSCO I"'WA!lHINOTON ,RATE GAlLONS SUIlJI:CT TO CREDIT OIIESE!. OTHER (.'5) ----------- ----------------- ----------------- ----------------- -----ii.,----- - _____~n__ n__u ____u,._ _u - _n - - '._,n -- ___ n __ Uu __ - - u___ __ - - ---i,i., _n u ----------- ----------------- ----------------- ----------------- -----ii.,----- -.--------- ----~------------ ----------------- ----------------- -----ti~----- ----------- ----------------- ----------------- ----------------- -----ii.,----- ----------- ----------------- ----------------- ----------------- -----ii.,----- ----------- ----------------- ----------------- ----------------- -----~n'----- CARRY TOTAL. ROUND EO TO NEAREST WHOLE GALLON, TO LINE 8, (D) TOTAL GALLONS_ ~':' " FI" '''''~'~f1 ~ "~Il~ Vl'llh 1M 1;la'e of Wa'h,ngton. o.p,tl1menl 01 Motor "ehiell... Fuel Ta. OI...lalon. P,O BO)( 2228, Olymplll, W.'hlngton 98S04 AVOID PENAL TIES, RepOrt, .,. due on N belor. '''. 25m d.y 01 ,,,,, month lotrcwlF1Q UIO. A tn.rgo of 10 percent phi' mlftreSl .1 Ihe r.le Of 1 PfIrc:nnt per monlh of Ihe In due will tkt .....Nd jOt I.t, repo#11 OUIIICI Inqlllflltl 10 'tI. rvtl'l Te. C)lYlllon or TelllphCn., (206) 7~:l'61lOO DISTRIBUTION' ORIGINAL: To Department ot Motor Vehicle. DUPLICATE: Special rue' U'~"I COpy " ", ':",; , "; """"" . ,', , " "':""" " :...' '.''','. ,,," .:": ",' ',', .' I' \i:::,~,;/,',' .: , · 1- ,", " ','.,,' ',',. ~:' ,', ';.:"" " ill1iI1'I'r;!; '." "" '~h,..""" . . ", ,'''':,''l[, .,',:i, . :..),: .";" ',,',", """'-. ..... I.L " " i.., ,';,', . " .....- , ,,' ',',.,:"", " '", " :':," ,,' ,,, .: :.', ", .,'.. ,> ,"',; , , ',',,' ,,:, ~ Gallons used In Washington to operate power pumping units or power take-off equipment (a) on dEtlivery trucks pumping propane, SCHEDULE B- /~ee~' ~~~r~~troe~t;~~e~:~S or (h) for other purposes if motor vehicle is equipped with a metering device approved by the department.. Claim c,red!t for three-fourths of a gallon for each 1000 gallons pumped. . Example: (140,000)( .00075 = 105 credit gallons) . DELIVEFn METER REA,OINGS ,,;' " : : , ,,', , :: ' : " ':, " .. ',' , ", ','" '" .., " ' ',':" ,:,:,.'''" ';, .'", ," ',' , "', . DEDUCTION DETAILS. IIF MORE SPACE IS NEEDED. ATTACH SEPARATE SHEETS) SCHEDULE A _~:~OI'~~t~~~~o~ns;;:~~~.jngIOn public roads in motor vehicles exempt by statute Irom special fuel lax. Claim credit or gallons 0 special fuel used on Washmgton public roads while operating: (A) Motor vehicles using propane or natural gas. (8) An urban transportation system over a prescnbed route within a 25 mile radius of corporatecounly limits. VEHICLE OR FLEET NUMBER TOTAL GALLONS OELlVEAEO INTO VEHICLES G/llLLONS USED ON WASHINOTON PtJBLIC RO"'OS CARRY TOTAL, ROUNDED TO NEAREST WHOLE GALLON, TO LINE 7 (100%) -----{100O/o)- --- - - - - -(100%) - - -- -----600%)---- -----(101JG1o)--- - -- ---(l00~o)---- -----600%)---- -----(100;;;0)---- TOTAL GALLONS ~ VEHICLE OR FLEET NUMBER TOTAL GALLONS PUMPEO -;- (.00075) - ---(:00075)---- - - - - (.00075) - - -- ---- (.00075)---- ----(.00075}---- ----iOO075')-- -- ----('.0'0'075')---- ----(.00'075)---- -~---~----- CARRY TOTAL, ROUNDED TD NEAREST WHDLE GALLON, TO LINE 8 IA). TOTAL GALLONS_ , ;'::': ", GALLONS SUBJECT TO CREDIT DIESEL OTHER GALLONS SUBJECT TO CREDIT .. SCHEDULE C. ~~~I:t~a used In WashIngton to operate a power take.oll unit on cemont mlker Irucks and load compactors on garbage Iruck,s, (see Instruction Claim credit for 25% or the gallons .of special fual used in Washington. Example: (3000 gallons x .25 '" 750 credit gallons) VfHIClfOR fLUT NlII,l"tA TOTAL nAUQJ.l!l OELIVEREO jNTOV[IllCloES MILESH,AVf:t,EO IN WASHINGTON CALloON' USEO IN WASHINGTON (,2'1 ----------- ----------------- ----------------- ----------------- -----i2~----- ----------- ---..------------- ----------------- ----------------- -----i2~----- ----------- ----------------- ----------------- ----------------- -----i2~~---- ----------- ----------------- ----------------- ----------------- -----i2~----- ----------- ----------------- ----------------- ----------------- -----i2~----- ----------- ----------------- ----------------- ----------------- -----i2~----- ----------- ,----------------- ----------------- ----------------- -----i2~----- CARRY TOTAl, ROUNDED TO NEAREST WHOLE GALLON, TO LINE 8, (B) TOTAL GALLONS_ .' CALLON' SUBJECT TO CREOIT OIE$Elo OTHER ~jl. thl. report and rtmlUance wUh Ihe Slalt' of Washington, O.,pllrtment of MOlor Vehlchu, FUfll h. Olvllion, P.O BOX 2228, Olympia. Wuhlnglon 98504. AVOID PENAL TIES. R.po,1. .rlil due on or before 1110 2SIt! day of Ill. monlh lallowlng ule A ehllrgo 01 10 pltre.,nl plUI .nl,,,ell at Ihft 'alt 01 1 parce"l per month of the llll due MI' be ....fl.....a tor "Ie report. Ojrltcl inqlllll'" 10 Ihe Fuel T.. Olv,'lon or Tel811hono (206) 75]-6900. DISTRIBUTION. ORIGINAL: To Oel1artmonl of Motor Vohieles OUPLICA TE: Sceei.lll 'ufll u!!oo,', cOpy " """ ',' ," , " , "," ,~,: " "" ",', ": . :':," ': , ..:: .' . :' , ,~ , ,... ,,: ',':, " :':;": "", :'::,,',' ,,:,;' , > ,:' ".. 'i:"", ' " '.',' ':" """, ,','>i:', ':, :,' '>(;':", ' , :,', ",:' "" :,:'" , ,,'" '>,i," ,,' " ::' ,,'., '''',' " , , '."'f, . :;::' ": ',""." \ :: ,,\ :.. ,; " " '.., ;;:'"il\'.: ,,", SPECIAL FUEL LICENSE NO. FT.441-112 (A \1-761 DUPLICATE SpAL FUEL USER'S TAX REPORT STATE OF WASHINGTON-OEPARTMENT OF MOTOR IIEHICtES .. FUEL TAX DIVISION P.O. BOX 2228 OLYMPIA, WASHINGTON 98504 REPORTING PERIOD.MONTH Mav 31.. " 1JL- D NO OPERATIONS DURING MONTH o Jr.r1gHII~~td~ARA~W~~lN. .pIRE~,~~f>~J IN o LICENSE IS RETURNED FOR CANCELLATION NO. OF VEHICLES OPERATED INTO AND/OR IN WASHINGTON USE SPECIAL FUEL INSTRUCTION SHEET AS A GUIOE WHILE COMPLETING THIS FORM COMPUTATION OF TAXABLE GALLONS }3AI.LONS~UB.JECTTO TAX-"(SHOWSEPARATE MILES ANO GALLONS FOR DIESEL FROM OTHER SPECIAL FUELS) :.';'. OIESEt',:,', ~,'D}6THER':_' DPROP~N( DNM.......t~ (DIESEL ONLY) 1. MILES TRAVELED IN ALL STATES (INCLUDING CANADIAN PROVINCES) TOTAL GALLONS OF FUEL USED IN ALL STATES (INCLUDING CANADIAN PROVINCES) 1528 191 AVERAGE MILES PER GALLON (LINE 1 DIVIDED BY LINE 2) ROUND, TO TWO DECIMAL PLACES (0.00) 8' 1523 ,MILES TRAVELED ON WASHINGTON PUBLIC ROADS. TOTAL GALLONS OF FUEL USED ON WASHINGTON PUBLIC ROADS (LINE 4 DIVIDED BY LINE 3) ROUND TO THE NEAREST WHOLE GALLON. ,DEDUCTIONS '(USE COMPUTATiON SCHEOULES ON REVERSE SIDE) GALLONS OF FUEL PURCHASED IN WASHINGTON SPECIAL fA} FROM SERVICE, STATION, KEYLOCK, OR OTHER FACILITIES FUEL TAX PAID OELIVERED INTO VEHICLE FUEL SUPPLY TANKS (61 TAX PAID WITHDRAWALS FROM YOUR OWN BULK STORAGE. 191 GALLONS OF FUEL USED IN MOTOR VEHICLES EXEMPT FROM SPECIAL FUEL TAX - FROM SCHEDULE "A" GALLONS OF FUEL USED TO OPEAATE POWER PUMPING UNITS OR POWER TAKE-OFF EOUIPMENT. fA) ON DEloIVERI" TRlJCICS PUMPING PROPANE, FUEL OILS, OR I1EArlNO OlloS, OR MEASURED SI" MffER,NO eEVICE APPROVED SI" THE DEPT,.FROM SCHEDULE -B" 18} 0"< CEMENr MIKERS AND LOAD COMPACTOR GARBAGE rRUCI<$-FROM SCHEDULE -C' TOTAL GALLONS DEDUCTIBLE (ADD LINES 8 THROUGH 8) NET TAXABLE GALLONS TorAL GALLONS ON WHICH TAX (OR CREDIT) IS OUE (SUBTRACT LINE 9 FROM LINE 51 IF LINE 9 IS GREATER THAN LINE 5, INDICATE CREDIT BY PARENTHESES, COMPUTATION OF TAXDUE" " ,.,' ;"', TAX DUE FOR REPORTING PERIOD TAX CUE lOR CREDIT) ( r: PER GALLON ON GALLONS SHOWN ON LINE 10) INDICA TE CREDIT BY PARENTHESES. PENALTY FOR FILING AFTER 25TH OF MONTH I'D PERCENT OF LINE "I 17 19 INTEREST FOR FILING AFTER 25TH OF MONTH II PERCENT OF LINE ") TOTAL DUE (OR CREDIT) FOR REPORTING PERIOD (ADD LINES" THROUGH 13) INDICATE CREDIT BY PARENTHESES. TAX ADJUSTMENT FROM PRIOR REPORTS TAX ASSESSMENTS (OR TAX CREDITS) FROM PREVIOUS MONTH(S). INDICA TE CREDIT BY PARENTHESES. NET AMOUNT OF TAX (OR CREDIT) DUE, (LINE.. AND IS). 'INDICATE CREDIT BY PARENTHESES. : MAKE REMITTANCE PAYABLE TO STATE TREASURER. (NOTE MAILING INSTRUCTIONS ON REVERSE SlOE 17 19 17 19 I ~ i ~ 'ND OF A TAX CREDIT ON LINE 16 MAV DE CLAIMED ON THIS REPORT IN LIEU OF FILING A CLAIM rOR REFUND \HECK BOX IF YOU WISH TO APPLY FOR REFUND OF OUTSTANDING TAX CREDIT AT THIS TIME. :" UNOI.. '"I 'fNA&.f1U 0' ptlUUlIlY Tl4AT THII IIII..ofllT, INCLUDING ANY ACCO"~ANYINQ ICHfDULU 0" IUTlUIN"," TO THIIIIT 0' MY tl:NOWLIDGI '''''ICT ...NO COII"-ITI. , \ v~.' C &...-6,..... TlTL,Jlirector. Dept, of Public IJorko : . '~t:,~350S rR(rARtO AT Port TO\mAend. WA 93368 DAn June 8. H171- ; };}6 ; "",,~~~"'..."" . ,...: ....... ". ..' ,. . j.,~,.,.:...' .... ...........;~~~r. ..' .... ,: ..... ....:. .. ..... i"' .... '. .... . . '. . .' '.;' .,. (. :., ..' '. ..... '. ',:. .... .': '."- ..:.... .~. '; ".::. :. . '.' . .:: ',: : .'. ...' :.:;},;}!;N.0' . :' '. ; . .....;. .:; .... ~~~~ti:Y ..:. · . ..,;" ..... .' .... .., '.' ~ . ~ .' .... ....... ,. c: ". . DEDUCTION DETAILS'- Ill' "'O~E SPACE IS ",EEOEO. ATTACti SEPARATE SHEETS) '. .. ". SCHEDULE A -~:~Oj~~'t~:~o~n s~e~~~.lngIOn public roads In motor vehicles exempt by statute from special fuel tax. Cla(~) C~;t~r'~~~i~~~Sn~s~~:~r~~an~e~rU~:~u~a~ ~~~hingIOn publ c roads while operating: (B) An urban transportation system over 8 preSCrlbed roule within a 25 mile radius of corporale county limits. VEHICLE OR TOTAl.. GALLONS OELlVliRED .' GAllONS USED ON FLEET NUMBER '. :" INTO VEHICLES ," WASHINGTON PUBLIC ROADS . _:il~~.._-";..,_.:._ ,,.-----",--').cc-~c.--., . (100-10) ====J!~~[==== ======== (100010) -----iiOoti.)'---- .-------- -----(1DcW.)---- -----i'Oo%)----. . -----~~)'---- -------- ----(100%)'---- -------- ,....,..... :.,.;' '. ----------------- .:c. .... J TOTAL GALLONS _ CARRY TOTAL.-ROUNDED TO NEAREST WHOLE GALLON, TO LINE 7 .:: " . .';. 'ill'! GaUons used in Washington to operate power pumping units or power take~off equIpment (8) on d~livery trucks pumping propane, SCHEDULE ~~ ls~~ ~~~r~~tr::t~~~e~:~s ,or (b) for other purp~.ses if motor vehicle is equipped with a metering device approved by the department. Claim credit for three-fourths of a gallon for each 1000 gallons pumped. Example:' (1'~O.OOO x .00075 " 105 credit galtons) VEHICLE OR FLEET NUM8ER DELIVERY METER Rf"'OINQS ENO ,;, START ....... TOT""LO""LLONS PUMPED :,c. ',,' RA!E ,. (.00075) . ., ----'(.00'075)---- ----(.0'0075)7--- ----'(.00075)'---7 ----(.00075)---- ----(:00075) ---- ----(.00'075)---- ----'(.00'075)---- . . -,---------- ." " . ,..---------- .:..;.::~:.::._'.;:,'1.::..::__ :" ";'.' '.....:. "', ,r.-. ----------- -------- I ----------,- ...~:::._-------- . .f:, '-,'.",-' -.----.--- CARRY TOTAL. ROUNDEO TO NEAREST WHOLE GALLON. TO LINE 8 (A), TOTAL GALLONS _ . .. :<....;;:......::..........: . . .. ......... ..... ......... !.'S6~;EO'U-l'E C. Gallons.'u~,d In WashIngton to operale 8 power lake-off unit on cement mixer trucks and load compac:tor~.on gar~age truck,s. (see Instruction sheetl . ClaIm' credit 10r.25" 0' l~e gallons' of special fuel used in Washington. e)lample~ '(3000 gaUons x ,25" 750 credit gallons)" ,." :,' ,.,' ..... vtt1lCU 0" "LUT HweE'! ,.' a""LLONS useo IN W""SIIINGTClN GAoLLONS SUBJECT TO CREDIT TOTAL GAlLONS OnrVER(O 1","0 YfHICLES MilES TJlAV!LEO IN WASHINGTON (.25) ----------- ----------------- ----------------- ----------------- -----~i~----- ----------- ----------------- ----------------- ----------------- -----~i~----- ----------- ----------------- ----------------- ----------------- -----~i~----- ----------- ----------------- ----------------- ----------------- -----~i~----- ----------- ----------------- -------.---------- ----------------- -----~i~----- ----------- ----------------- ----------------- ----------------- -----ii~----- ----------- ----------------- ----------------- ----------------- -----~8j----- CARRY TOTAL, ROUNDED TO NEAREST WHOLE GALLON. TO LINE 8. (8) TOTAL GALLONS_ -'--.--'--- f.J " ,; :/ file 1t"..,.por1 Met ,.",m."e. Wllh ttle 51.'. of W.."lnglon, Deparlmflnt 0' Molur Vehlef"s. fuel Ta. olvl.IOn. PO. BOX 222S. Olympia, Wathlnglon OSSO", 'AVOID PENA.L TIES RepQfl. are due on Of belor. 'tie 251t1 dly 01 'till mQ"lh lollowlrlg us.. .... chargft 01 10 percenl plu. Inler..l II I"'. rate 01 1 rercent p.r monltl 01 ,he till due Will bel .....H'd 10f" la'e ffopoOf(. OHOCllnqlllflllS 10 t"" fuel Tal( DIYI,lon or Tel~pho"e (:lDe) 753.6900,' ~',:,:;>' DISTRIBUTION. ORIGINAL: To Department 01 Molor Vehicles OUPLICA TE: Special fuel uSGr'. copy .- .: ...;. : ... :.... '.' ..... '.:<." ,! .;...... . ... ',.' .' . ,": .', ,: .....J;. . ' ..:...... . '" '. ..>;' ......: .... .....-i .... "<:'.:;' :::. .....;., .~ . ..' ,.... L. SPEftL FUEL USER'S TAX REPORT STATE OF WASHINGTON-CePARTMENT OF MOTOR VEHICLES . SPECIAL FUel LICENSE NO. REPORTING PERIOD.MONTH FUEL TAX DIVISION OLYMPIA WASHINGTON 98504 March 30. D NO OPERATIONS DURING MONTH D THIS IS A fiNAL REPORT. OPERATIONS IN WASHINGTON D ~~~~S:E~SN RTEETRU~I~:ciE~OR CANCELLATION .......=--."'1:.1=-....._=-..=-_1.'........._.....,-.....:.=-=-_...___._~...'.~',l.:..III:=--....,'j.~.=-.....~.:...__=-....,.j COMPUTATION OF TAXABLE GALLONS :OIESEL ~~~{~~::~,~~~~~f~f€~~~..:.0(i~#~~f~f~1~:f~:;0~~f~~~::~~i.L~~~~.f~,R.~'~~~~~:~&~~-prH:ki';#;kf{~p~~#r~~ (DIESEL ONL VI 1. MILES TRAVELED IN ALL STATES (INCLUDING CANADIAN PROVINCES) TOTAL GALLONS OF FUEL useD IN ALL STATES (INCLUDING CANADIAN PROVINCES) AVERAGE MILES PEA GALLON (LINE t DIVIDED BY LINE 2) ROUND TO TWO DECIMAL PLACES (0.00) MILES TRAVELED ON WASHINGTON PUBLIC ROADS. TOTAL GALLONS OF FUEL USED ON WASHINGTON PUBLIC ROADS (LINE 4 DIVIDED BY LINE 3) ROUND TO THE NEAREST WHOLE GALLON. .':.;:~::.;;;;::;;;'~;:.~-:,;~;OEDUCTIONS';;(USE:;COMPUTA. TION"SCHEDULES:' ON, RE VERSE, SIDE);:" . ..,,;',::-:;..,:;,::~.:;.-::-: .,'>;,,>,:,::;-::;-:.;.-;.< 6. GALLONS OF FUEL PURCHASED IN WASHINGTON SPECIAL IAI FROM SERVICE STATION. KEY LOCK. OR OTHER FACILITIES FUEL TAX PAID DELIVEREO INTO VEHICLE FUEL SUPPLY TANKS. ra) TAX PAID WITHDRAWALS FROM YOUR OWN BULK STORAGE. GALLONS OF FUEL useD IN MOTOR VEHICLES EXEMPT FROM SPECIAL FUEL TAX - FROM SCHEDULE "A" GALLONS OF FUEL. USED TO OPERATE POWER (AIZ~fI..:-,:..ra~~Jlt~~~~~~~~~:'1~~A~~f.~$~8ltfc~:D1ftl!~g OILS. OR MEASURED BY PUMPING UN/TSOR POWER TAKE-oFF EQUIPMENT. fBION CEMENTMIXER$AND LOADCOMPACTDR GARBAGE TRUC/($,'ROAtSCHEDUl.E ''C'' TOTAL GALLONS OEOUCTIBLE (ADD LINES 6 THROUGH 8) 'i~;:::;:,._;~:..::;.<<.,;~ NE1>:TAXABt.:E,;:.GALlONS ;';' '. ..'.-. ';;:,:,-:.~~:;;, 10. TOTAL GALLONS ON WHICH TAX lOR CREDIT) IS DUE (SUBTRACT LINE 9 FROM LINE 5) IF LINE 9 IS GREATER THAN LINE 5. INOICATE_-E.REDIT BY PARENTHESES. COMPUTATION OF TAX DUE /.'TAX:DUE'.FOR 'REPORTING PERIq)>" _ TAX cue lOR CREDITI (9ft PER GALLON ON GALLONS SHOWN ON LINE 10) INDICA TE CREDIT 8Y PARENTHESES. PENALTV FOR FILING AFTER 25TH OF MONTH (10 PERCENT OF LINE 11) INTEREST FOR FILING AFTER 25TH OF MONTH 't PERCENT OF LINE 11) TOTAL DUE lOR CREDIT! FOR REPORTING PERIOD (ADD LINES t, THROUGH '3) INDICATE CREDIT BY PARENTHESES, .-; ;::.:~ ADJUSTM!BT' P~OM PRIOR. REPO'!!!_'A TTACH SUPPORTING DOCUMENTS!' TAX ASSESSMENTS (OR TAX CREDITS) FROM PREVIOUS MONTHISI. INDICATE CREDIT BY PARENTHESES. NET AMOUNT OF TAX lOR CREDIT) DUE. (LINE '4 AND '5). "INDICATE CREDIT BV PARENTHESES. MAKE REMITTANCE PAYABLE Te,_~.!~lY_.!.!!.~.~URER__. (NOTE MAILING INSTRUCTIONS ON REVERSE SIDE). '~rrl)NO OF' " TAX (:R(OIT O~ l'''-'f ,,, "'AV fiE CLA1....EO ON THIS REPORT IN LIEU OF FILING A CLAIM FOR RHUNO D CHECK BOX IF YOU WISH TO APPLY FOR REFUND OF OUTSTANDING TAX CREDIT AT THIS TIME. 920 115 l3 920 115 0 0 0 0 0 0 115 CENTS $ 10 35 10 35 i .. ... ~ .. :l " . 10 35 I Cf.RTlfY UNDfR THE 'H~"'l.lIU OF PERJURY THAT THIS Rtf'ORT.INCLUDINQ ANV ACCOMPANVINQ SCHEDULES OR STATEMENTS. II TO THE BUT OF MY KNOWLEDGE TRur.COARECT AND COfMLlTE -;'-;" /; /~-,'"i-. ./ Director, Del'srtlllent of Public Workto "GNA""! X --'---'JSS-';:JS{l:5"-,_L . :--P;---E--r'i- "T!' if:h~jr,g- l1USI"'r~~; "110M __._.__.___...__.__.___,_ PRfP^Rf n AT _~~~f!.!~,._____.~DATE .. . " , ~ DUPLICATE SpAL FUEL USER'S TAX REPORT STATE OF WASHINGTON_OEPARTMENT OF MOTOR VEHICLES . FIRM NAME SPECIAL FUEL LICENSE NO. REPORTING PERIOO.MONTH Januarv 31. MAILING ADDRESS fUEL TAX DIVISION OLYMPIA WASHINGTON 98!i04 CITY, STATE. & lIP o NO OPERATIONS OURING MONTH o THIS IS A FINAL REPORT. OPERATIONS IN WASHINGTON o ~~~~S:E~SN RTEETRU~I~~E~OR CANCELLATION ~~Olll .IIl [I....GI i~ to.'"l. "'OO"ISSO~ WI,.!"SI'" $''1r.I'"HIP,,.G.IP(l"' ,......-.......:11....._=-,.=-_...................,_...:.=-=-_.....__._~'.I..=-','.:..___..,',.....=-...'.~.:..._=-....," 1. MILES TRAVELED IN ALL STATES (INCLUDING CANADIAN PROVINCES) ~';':#l,D.IESeL.j'':;' ~~~A:L~ci~~'~u~je~+:T6 iA~' :./.fS~O~'SEP~RATE MILES AND GALLONS fOR: DIESEL FROM OiHER_iiECi~t/Fj;k{jjjt~~ ID1ESEL DNL YI _.~-:::.-:..-:-;<..-:;.'.;.:;.<,-,;.,';,~,<.,-'--.-~,-:,.>-.,'.,',.,..- "'J., , ",,~,_' ',:. ':...;.>-:..,:~';..-:..<:.:-::,:;-:.: TOTAL GALLONS OF FUEL USEO IN ALL STATES (INCLUDING CANADIAN PROVINCES) AVERAGE MI LES PER GALLON (LINE 1 DIVIDED BY LINE 2) ROUND TO nvo DECIMAL PLACES (O,OO) MILES TRAVELED ON WASHINGTON PUBLIC ROADS. TOTAL GALLONS OF FUEL USED ON WASHINGTON PUBLIC ROADS (LINE 4 DIVIDED BY LINE 3) ROUND TO THE NEAREST WHOLE GALLON. ;:;~;::::.~:;:.~;.:.;:?",.;:;;:";oeOUCl'JONS: (USE-,COMPUTA TIONSCHEDULES ON, REVERSE SIOEI " 6. GALLONS OF FUEL PURCHASED IN WASHINGTON SPECIAL (AI FROM SERVICE STATION. KEVLOCK,OR OTHER FACIL.ITIES FUEL TAX PAID DELIVERED INTO VEHICLE FUEL SUPPLY TANKS, fBI TAX PAID WITHDRAWALS FROM YOUR OWN BULl( STORAGE. GALLONS OF FUEL USED IN MOTOR. VEHICLES EXEMPT FROM SPECIAL FUEL TAX.... FROM SCHEDULE "A" GALLONS OF FUEL USED TO OPERATE POWER fAJ.e1ffld:S~~J,"t~~~~gt!:~~:1~~A!{pr.':'$~8fJ'ffc~:ri'Jtl!!Zg OILS. OR MEASURED BI' PUMPING UNITS OR POWER TAKE.()FF EOUIPMENT. ISION CEMENTMIXER.'i ANOLDAOCOMPACTOR GARBAGE TRUCKS. FROMSCHEOULE "C" TOTAL GALLONS DEDUCTIBLE (ADD LINES 6 THROUGH 8J . .:NETTAXABLE.GALLONS:.<.. TOTAL GALLONS ON WHICH TAX (OR CREOITl IS DUE (SUBTRACT LINE 9 FROM LINE 5J IF LINE 9 IS GREATER THAN LINE 6. INOICATE CREDIT BY ,PARENTHESES, ",_'TAX'OUE:,POR,'REPORTING PERIOD> " .', .,.".';::~___~;.::~,.:.;;;;..:..:.~-:;:,::...;: TAX DUE lOR CREDm (~PER GALLON ON GALLONS SHOWN ON LINE 10) INDICATE CREDIT BY PARENTHESES. PENAL TV FOR FILING AFTER 26TH OF MONTH (10 PERCENT OF LINE 11) INTEREST FOR FILING AFTER 25TH OF MONTH (1 PERCENT OF LINE 11) TOTAL DUE lOR CREDm FOR REPORTING PERIOD (ADD LINES 1/ THROUGH 131 INDICATE CREOIT BY PARENTHESES. -""',,;::%':-:<rAX:.....DJOSTMENT;FROM;PRIOR.REPORTS. (ATTACH SUPPORTINGDDCUMENTSJ ..; ;;..";~,.:",,,.;;~,;?~.; TAX ASSESSMENTS COR TAX CREOITSI FROM PREVIOU~ MONTHCSI, I~OICATE CREDIT BY PARENTHESES. . $ NET AMOUNT OF TAX lOR CREOm OUE, (LINE '4 AND '5), 'INDICATE CREDIT BY PARENTHESES. MAKE REMlTTANCE PAYABLE TO STATE TREASURER. (NOTE MAILING INSTRUCTIONS ON REVERSE SIDE). "REfUND OF A TAX CREDIT ON LINE 1ft MAV BE CLAIMED ON THIS REPORT IN LIEU OF FILING A CLAIM FOR REFUND. o CHECK BOX IF YOU WISH TO APPLY FOR REFUNO OF OUTSTANDING TAX CREDIT AT THIS TIME. 824 103 8 824 103 0 0 0 0 0 () 103 DOLLARS CENTS 9 7 9 7 9 7 I CERT.,... UNDER THE P'EN4LTlU OF P'EfUURV THAT THIS REPORT,lNCLUDiNG ANY ACCOMPANVING SCHEOULEI OR ITATEMENTI,I' TO THE IUTOF MV KNOWLEOOE TRUE. COAA ECT AND COMP'U TE, -- . /I ? "O..'U., xL::/~'O?....LJ.'_,,{' ./ A\,J:'i:IN(SS PHONE ~ ;;; i:I ~ ~ ~ ~ ! ~ 1w...L." U'stR"TAX REPORT Column 2. Column 3. Column. 4. Columns 5 & 6 . . Enter total gallons del ivered into vehicles. Convert CanadIan gallons to U.S.P. gallons by adding 20%. Oivide lotal gal Ions used into total miles traveled to determine th; average miles per ~allon. Divide the average miles into Washington miles to calculate the gal Ions used on Washington public roads. (se If-,exp I anatory) Enter total gallons exempt from special fuel tax, rounded to nearest ,whole gallon. Line 8. Total gallons of diesel fuel used in motor vehicles operating power take-off equipment which is subject to credit as provided in the Washington Special Fuel Tax Act. Repopt of gatZons of natupat gas op tiquefied petpoZeum gas used to opepate powep take-off equipment not pequiped. 8-A. Gallons of diesel fuel used in Washington pumping propane, fuel oils or heating oils by a power take-off unit on a delivery truck. Oetermine gallons deductible at the rate of 3/4 of one gallon for every 1,000 gallons of fuel delivered. (RCW 82.38.080) COMPLETE SCHEPULE B ON THE REVERSE SIDE OF.THE FORM TO REFLECT DIESEL FUEL USED TO OPERATE POWER PUMPING UNITS, POWER TAKE-OFF EQUIPMENT, ON PUMPING TRUCKS, OR OTHER PURPOSES IF MOTOR VEHICLE IS EQUIPPED WITH AN APPROVED METERING DEVICE. Co I UlM I. Column 2 & 3 ColUlM 4. Co I umn 5. Co I umn 6. Column 7. Enter vehicle(s) or fleet number for only those vehicles that qualify. 00 NOT INCLUDE VEHICLES' DELIVERING GASOLINE. (self-explanatory) Enter the difference between Column '2 and 3. (self-explanatory) Enter gallons obtained upon multiplying figure in Column 4 by .00075. Completion not required. 8-B. Gallons of diesel fuel used in Washington operating a power take-off unit on a cement mixer truck or load compactor on a garbage truck. Determine gallons de- ductible at the rate of 25% of the total gallons used In such truck. COMPLETE SCHEOULE C ON THE REVERSE SIDE OF THE FORM TO REFLECT USE OF DIESEL TO OPERATE POWER TAKE-OFF UNIT ON CEMENT MIXER TRUCKS AND LOAD COMPACTORS ON GARBAGE TRUCKS. Column I. Column 2. Column 3. Column 4. Enter vehicle(s) or fleet number for only those vehicles that qualify. Enter total gallons delivered Into vchlcles. Convert Canadian gallons to U.S.P. gallons by adding 20%. (self-explanatory) Divide total gallons used Into total miles traveled to determine the average miles per gallon. DIvide the average miles Into Washington mIles to calculate the gallons used on WashIngton public roads. c << <t u Z o i= <t u u:: i= z w C " ~!i. - !~! ; ~ - ~ co ~ . -0 , 0 D '" ' ~ " CO ~ ~ ~ w ~ 0> " i~~ , " :: :!. 0 . 0 '" 0 . V ~ U . ~ s; I~ ~If ~ ~;;: " ~ N " "" ~ ~~: i H > c--~~ , -rl , ., ~~ '" ~ ~ , 'H .c " 0 '" ~ OJ .1: , ;3' :~ I~ , v .., O:-m ~ , 1l 2 0< " Z > D! ~ ~ :z: 0 < Ii< ~ ~ ~ ~ ~ ~. < ~ ~ c : : ~ . 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"','., ", ". , . , .. , .:', :. i: '. '. """ ,:,.::.',. .. ".. :,''''.' ". ,:: . , '. " ,,' .,./l ........ >< . '.' ........... .:: ..':. . ... .".........'. .' . .'. ,. , . STATE OF WASHINGTON DEPARTMENT OF MOTOR VEHICLES LIQUID FUEL TAX DIVISION . USER'S USE FUEL TAX REPORT For State, Counties, Cities, and Urban Passenger Transportation Systems Name......n.... ....... ................. n...n n... ... ..... ....... ......................... ..................... h _........ .... _.'. ._,.... .... ...... Permit Number Address....... ........... ..................... .......... ................................. ............. .................. ................ Month..... STATEMENT OF TAX DUE THE STATE OF WASHINGTON '.' .' ".' .: . ','< . ',..:'. . . .. " " .' >. '. .- :'~':.; :" " . ....,. '. . ".:'c " . ..':'. . .................19.......... 1. Used on Washington Public Highways (Total Schedule 1. Column E) 2. Exempted Use for Highway Construction and Maintenance 3.' Exempted Use by an Urban Passenger Transportation System 4. Balance on Which Tax Is Due (Line 1 Minus Lines 2 and 3) -1 ,^'w'" :::::J____ __ $ " ". ',::"": ." .:\ ," , . :..' :." ..i,i,., .,'>: . :" Ii .;".'.:,. , ,.:,.:.' ,:',':': . ,:' .,;-" .' .'.. .. FUEL TAX. PENALTY. AND INTEREST S. Use Fuel Tax (Line 4 @ 9. ) 6. Penalty (10% of Line 5) 7. Inleresl (v., % of Line 5 ner Month Be.innin~ on the 21st) 8. Total Due for the Month (Lines 5 to 7) 9. Olher Debits or Credits (Explain) 10. Remittance Payable to Slate Treasurer SCHEDULE 1 - COMPUTATION OF FUEL USED ON WASHINGTON PUBLIC HIGHWAYS VIHICLI lDIHTlflCATlON Statlnll II r.'al MILlS TlAVELED C:r;~:Y Gall_. .r Wa.hlnUf,n fu.1 U.ect rotal ,...blle Hlghwan CAI III Co) I I I I I I ! I CDI Av.,alil. Mil.. p., Gallon W....I...'.. Lie..... N::':':'r H,"",", TorAL Submit report with remillnnce 10: Stnte 01 Washington. Deparlment of Motor Vehicles. Liquid Fuel Tax Division. Olyn'pia. Washington. If laX. is nol paid on or before the 20th day of the monlh. add penally and inlerest for delinquency as provided by Revised Code of Washington (RCW) 82,40.080. o Check here if Ihis is a final reporl nnd enclose use fuel lax permit and J. D. Cards. I. belflll dill)' amllOrl:t<I. IIereb)' certil)' ,lint ,111.. repo,' I.. /(} rM be." 01 my kno\l'ledge /rue. correc,. and "'II/'plere ill acco,daflce \1'1,11 cllOprer 82.40 ReII' ond appllcubl. ,..gulorla/l.'. Slgnalure H Date..... ........................... .. ... .... ...m...... 19.......... Dated at ........ ................... .................,...... TiUo.._..._..._. ;,:; ,":" 'r, :, ,''': :.,', .:' !..<. " . .' :. . . . .. "c>, ,'.'. 0,: ':';'. ' :: ,.- .c. ',:" ':, . ......... $ Is Gallon. o' '....1 Vied an Wa.~~t:r:blle III ~ ~ = ;:; :;:. ~ ... F'om Ho. UF 507 - .. : ~ ;'" ), d " ".; ; ,.'" ::\',',:> \"""- ""'"---. , ..:, . :',7:", ,.: :' ", ,'"',, ',: ,; ", ";: "\' ,,' ie"~ :,. :. "",' ": ".' . . " : .;', .. ' .. ""'::',,,: . " . , . , . SCHEDULE ,- INSTRUCTIONS 1. List each vehicle for which a Washington I. 0, number is required. 2, Compute column 0 (Average Miles Per Gallon) to two decimal places by dividing column B by column A. 3. Compute column E (Taxable Gallons of Fuel) to the nearest gallon by dividing column C by column D. 4. Space is pcovided foe ten vehicles, if moce ace operated in Wash. use Schedule 1 (Supplement). Supply is available upon request. SCHEDULE 2 - DETAIL OF WASHINGTON FUEL RECEIPTS (S~""ice Slalion Receipts Only) INVOICE SELLER WASH. I.D. NUMBER GALLONS INTO VEHICLES DAn HUMI.. HAM. LOCArlON . TOtAL SCHEDULE 2 - INSTRUCTIONS J. Washington purchase invoices in detail must be IIsled by each vehicle. 2. The gallons listed for each purchase Invoice should be carried to the nearest whole gallon, Use even 8il110ns-<10 not show tenths. . '.i : ", . : .,"." , " . ':",'" ,,'\..,', ' :,' ,\ :::,:, ,,' ..,'.'j. ,: ";:." . . ~~'21;1Iillm~I\I~111I!tmt\"l'11~ ~ "'" .: .' . , . .. . . " ..:....'.',..,. . :" :: ,.;, .'- . . -.:.'; :" ':: . :, :,", '.: i.. , ,:., ,.i}~~,!,;{; ;" ;,;'; I " ":'; "","" :' ": ....01 :': . "'- "~'.".," ~ ',' , ,'::i", ':'..','\>: "', ",';".. " . .'::,;, , 'C" . ".... ,'" .... . .. " '.' ',' :,". ''',' " ..r " '" ...... ...' ',' . '" ...... : , 'C '.' , " .: ; .', . .,' '", . c. c, .> > ' ','>, :.: 'c" ....< , , . . STATE OF WASHINGTON . DEPARTMENT OF MOTOR VEHICLES LIQUID FUEL TAX DIVISION USER'S USE FUEL TAX REPORT For State, Counties, Cities, and Urban Passenger Transportation Systems Name..n.................................................................................... ..............................._.._ .............. Permit Number.. l' ':.'.: : . Address.....: ............. ............. ....n._.. ..... ..... ................................... ......~.... ............. _ '... .. .... Month.... . ...., 19........., STATEMENT OF TAX DUE THE STATE OF WASHINGTON FUEL II GALLONS ~ I I .---- -- $ I i/ $ .. i,' 1$ I. Used' on Washington Public Highways (Total Schedule I, Column E) 2. Exempted Use for Highway Construction and Maintenance 3.. Exempted .Use by an Urban Passenger Transportation System 4, Balance on Which Tax Is Due (Line I Minus Lines 2 and 3) TAX, PENALTY, AND INTEREST 5. Use Fuel Tax (Line 4 @ 9. ) 6. Penalty (10% of Line 5) 7. Interest (V" % of Line 5 ocr Month Beninnino on the 21st) 8. Total Due for the Month (Lines 5 to 7) 9. Other Debits. or Credits (Explain) 10. Remittance. Payable to State Treasurer SCHEDULE I - COMPUTATION OF FUEL USED ON WASHINGTON PUBLIC HIGHWAYS . VEHICU.IDIN1UICAflON s..lln, II Tated MILES TlAVILED Gallon. at '. A....rall. Fu.1 UMd_ ':ri:1 Gallon, .f Walhlngton Mil.. fu.1 Uled Totell Public p.r GaUa" W.'~ieC~bllc Hlghwa.,.. IAI (II lei IDI III W_'....... Uw"ae N~ H-""r TOTAL r- I I I Submit report with reminanee to: State of Washington. Department of Motor Vehicles, Liquid Fuel Tax Division, Olympia. Washington. If tax is not paid on or before the 20th day of the month, add penalty and interest for delinquency as provided by Revised Code of Washinglon (RCW) 82.40,080. o Check here if Ihis is a fin.l report llnd enclose use fuel lax permit and I. D. Cards. I, bring d/lly allll",ri:"I, ""tby urlif)' ,"a, ,lIis "port i" /0 tilt b.., 01 my knoll'ltdlle /r/le, correct, and ",,"'plete III accordallce wit" c"apter 82.40 RelY and applicablt ..tgl/latlons. ~ '" ;;; .. ",' s :; Signature ... TiUc__.__...... Dllte. ."......,19." Dllted at Form No. UF .s07 .. . '. :: , :', ", "" . " , '.,,, :,' ... .,' ...... '. . ,'.' .:: . ':,..' . .. :: . , , . "C..' . . - i ': " .... " ,,: , '.... C.': - in~ .i,.. , ':: ~j>)i.. """. .. --"" c'c j , i.,.. ... .... j;~}~lJ~~~~jl .....'... . . < :C""., ...:'c. ":../ .~ ,.c . .:" ':'.c' .: '" :- '. ,....;;.: IS ", ':.,"j . ..'':: '. .... . .. .ii" j.? ':,: r'c '.,"',.:. .' :,. ii:'} SCHEDULE 1 -INSTRUCTIONS '.<,,;.: ". ." 1. List each vehicle for which a Washington I. D. number is required. :../ 2. Compute column D (Average Miles Per Gallon) to two decimal places by dividing column B by column A. ,0; "i. 3, Compute column E (Taxable Gallons of Fuel) to the nearest gaIlon by dividing column C by column D. .;>..i 4. Space is provided for ten vehicles, if more are operated in Wash, use Schedule I (Supplement). Supply is available upon request. SCHEDULE 2 - DETAIL OF WASHINGTON FUEL RECEIPTS :..F: ~; (Servic~ Station Receipts Only) INVOICE SELLER WASH. GALLONS .'.:..., r,D. INTO DAn HUMin NAME LOCATION NUMBER VEHICLES i'': i'::'.c .!: . .', I. e , . ,. ... , , . .. io. .,c- .. . " . '. ,. . ,j '."\ / ;.. O),{ 'j' ..,:,. " TOTAL SCHEDULE 2 - INSTRUCTIONS I. Washington purchase invoices in detail must be listed by each vehicle: 2. The gallons listed for each purch.se Invoice should be carried to the nearest whole gallon. Use even 8:1l1ons-<lo not ,"ow tent"" . . i. , }, ':fi""': , .. . , ~~i,~i 'F?:i."., '.'. "0, j :" '" ':....;:,; ,...,..' , " ,.:,; ... ,,'J;.: ," ....i"'{': ..:A , :.< /" .,i,..:,') i ,,:'..... .',.,:; ~ " . , \/".""" ......., .' . i..' '.~ ""'-- ..:.oi "'en ' i.... ' , .......... ',. .' ',. '.', : . :.,' . .: , ". . ..' " .7111 :.' ...: ..".!J1 . '. : . '. ..... . .,:. ': ........,. '.' .>. ," '" .'." .: .' 1 ... . STATE OF WASHINGTON _ DEPARTMENT OF MOTOR VEHICLES LIQUID FUEL TAX DIVISION ., USER'S USE FUEL TAX REPORT for State, Countios, Cities, and Urban Passenger Tran5partation Systems '. . Name............................................... ....................................... .... ....... . . .. -................. Permit Number..... ... Address...; ..... ............. .....n .... ................ ................. ..nn.... ..............._ ,... ..... .............. .... ....... Month..... .. ....... 19.......... ./: . FUEL STATEMENT OF TAX DUE THE STATE OF WASHINGTON 1. Used on Washington Public Highways (Total Schedule I, Column E) 2. Exempted Use for Highway Construction and Maintenance 3. Exempted Use by an Urban Passenger Transportation System 4. .' Balance on Which Tax Is Due (Line I Minus Lines 2 and 3) II ""'"$ -l__. __ 1$ I i TAX. PENALTY, AND INTEREST S. Use Fuel Tax (Line 4 @ 9t) 6. Penalty (10% of Line 5) 7. Interest Ph % of Line 5 per Month Bei(inning on the 21st) . 8. Total Due for the Month (Lines 5 to 7) 9. Other Debits or Credits (Explain) 10. Remittance Payable to State Treasurer $ I $ SCHEDULE 1 - COMPUTATION OF FUEL USED ON WASHINGTON PUBLIC HIGHWAYS YIHICll IDENTifiCATION II Tolal hotlnll C:ri~:' GalJ_lo' W...."-.... L1Uf1.. fV11 U'N I. D. ....... ....... (AI I I I ! I I TOTAL .1 MILES TRAVELED (0' Oallotl. .f Fu.1 UlMI on W4:~'I:~UbIlC "' 1'1 WOlhh'SIItotl '",bile Hl"hwo)'l (CJ AII.rall' Mil.. per Oedlon Tlltell Submit report with remittance to: State of Washington. Department of MOlor Vehicles, Liquid Fuel Tax Division, Olympia. Washington, If tax is not paid on or before the 20th day of the month, add penally and interest for delinquency as provided by Revised Code of Washington (RCW) 82.40,080. o Check here if this is a final report and enclose use fuel lax permit and I. D. Cards. J. b~;ng dilly nwlm,;ud. IItr~b.l' etrl;/)' IIInt III;s '~"Orl ;s 10 III~ best of my knol\'l~dg~ ITII~. correcl, and ('(",rplrle 111 QcC'orllancc wit" chapuT 81.40 RCW and applicable regulations. ~ ;;; .. "" Signature....... ................._... .................._........_.............. Title..._.__..... ................m....._...... ................. _....... ....__.... Oale...m..............._..._.......... ..........19...m.... ~ .. Dated at m._. Form Ho. UF' 50'7 ::." '". ..-,.i:,", ..' '. ...... . .>.' .... .......... . , . .. .. ....J:.. .' . ". . i ,'. . . ....... :', .: :>.. ;~!',':,:. . '. :"'. , ...."'..., ..,: . ,.:::'. .;'" :,' .:.. '" ',,..' . .':-:" ", " " :'. .. " :'" .:, :', '. .'.: _..iOiiI ... .; .( .,.. ,: ',. ,:..... ;, ....., '" :. . ..' .' '. .'. .'. '. '. : , . '. . '. :~', .[7. ..' . SCHEDULE 1 - INSTRUCTIONS L List each vehicle for which a Washington l. D, number is required, 2, Compute column D (Average Miles Per Gallon) to two decimal places by dividing column B by column A. 3, Compute column E (Taxable Gallons of Fuel) to the nearest gallon by dividing column C by column D. 4. Space is provided for ten vehicles, if more are operated in Wash. use Schedule 1 (Supplement). Supply is available upon request. INVOICE DATI HUMIII . '. . . . . ..... .... ". . ,. ....:....: .. , , , . , .' .'. . .'. '. '. SCHEDULE 2 - DETAIL OF WASHINGTON FUEL RECEIPTS (Service Station Receipts Only) SELLER NAME LOCATION WASH. I.D. NUMBER GALLONS INTO VEHICLES forAL SCHEDULE 2 - INSTRUCTIONS I. Washington purchase invoices in detail must be listed by each vehicle: 2. The gllllons listed for each purchase Invoice should be carried 10 the nearest whole gallon. Use even gallons--do no/ show remhs. L.. '~~'~:""':' '. :' ." .,.. ' :..' ,,' . .... " :"', .:; ',> '.7:::;""" \(, ~:". : . . ~J ..' '. . .' .'. ..', " ,,' : ..' '. " ....: .',', , "..>'. --,. .. ,., ..' '. '. '. . ..'. :. "', ;. ,........... .', . . '> ; '. : " ,". :. ''':'' ti' " ,'> .. .', .' :." .. "., .: ,'. " ..,;. ,', : .. .... :: '."; ')'i . " '.. '.': :T' <'..> " .. ., "'. ". " , "'" :;; , . , : , I,"~ ",.it .~ : .' I I .__.__ ~~- ."'''/''. .'.'i_ 'c" . . :' . '.,'" ....... '::, '::. ., ',',' " :..' .",' " .f '. . .'" . . . ,,':" .; '. ". . , . '.. ;i:, . .... : .:. .... .. .... " .' . . . STATE OF WASHINGTON . DEPARTMENT OF MOTOR VEHICLES LIQUID FUEL TAX DIVISION USER'S USE FUEL TAX REPORT For State, Counties, Cities, and Urban Passenger Transportation Systems Name........;..... ............. ............ ............ n.. ........n ......... ............ ........ n.. _............. ......... ........_..... Permit Number..;........ Address. ..h. Month'hh STATEMENT OF TAX DUE THE STATE OF WASHINGTON FUEL . 1. Used on Washington Public Highways (Total Schedule I, Column E) 2. Exempted Use for Highway Construction and Maintenance 3, Exempted Use by an Urban Passenger Transportation System '4. Balance on Which Tax Is Due (Line 1 Minus Lines 2 and 3) TAX, PENALTY, AND INTEREST 5. Use Fuel Tax (Line 4 @ 9<1) 6. Penalty{IO% of Line 5) 7. Interest (Y.z % of Line 5 per Month Beninning on the 21st) 8. Total Due for the Month (Lines 5 to 7) 9. Other Debits or Credits (Explain) 10. Remittance Payable to State Treasurer SCHEDULE I-COMPUTATION OF FUEL USED ON WASHINGTON PUBLIC HIGHWAYS VIHICLI IDENTIfiCATION MILES UAVUED Sealln" C:ri~:' Tolal Gallon, .r Fuel U.ed Avora.. Mil.. p.r Oelllon hl.1 WOlhln.ton ,.,blle Hllhw~ tCl (D) W-r.'D~'- Lie.,... Nu....' Nlt/fllber (A) II) i I I I TOTAL l Submit report with remlllance 10: Slate of Washington, Departmenl of Motor Vehicles. Liquid Fuel Tax DivisIon. Olympia. Washington. If la. is not paid on or before the 20th day of the month, add penally and Inlerest for delinquency as provided by Revised Code of Washington (RCW) 82.40,080. o Check here if this is 0 Iinol report and enclose use fuel ta. permll and I. D. Cards, I. be;"g d"ly awlwrl:.ed, hereby certify ,lrat tills report i.f to lire he.u 01 my knowledge trlle, correct, and ""mp/~1t In accorJanc~ ...1111 cllal"u 8].40 RelY nnd applicab/~ regularloM. Signature Dale..,......,.................. ...... ................ 19.......... Daled aL....... ... ................. TiUe..._..._..,.... .............................. ................ " : ."', .....:. '..:.,,'. ? '., ','. , ;' .... , "". - , , . ",', ;' . :. '<:" .~, "', ' :/:"'. . , ..... .' ,".' . .' .' ......' .' ..,19.......... ~ GALLONS $ 1$ . '. GalllWll.f ..,.1 Unci on Wa.~~tw~ubUC II) .' ~ = .. ~. ~ .. Form No. UF 507 <": .. 7' . ,'., . :. .... . . . ..:.....:. , ':".; <..Oi ;.' " " ,C~ ) I ~. .... ..... "'. :....::: "'J'. '.'.'. . .,' .:'.' . ". - ...,.... :.., . '. . . . . '. '.' '. .- ..,' I '; . .," , ,". '. :i.... '., . ,i;'. :.... .'. j:.:. : ., ". C' , '. SCHEDULE 1 - INSTRUCTIONS 1. List each vehicle for which a Washington I. D. number is required. 2. Compute column D (Average Miles Per Gallon) to two decimal plnces by dividing column B by column A. 3, Compute column E (Taxable Gallons of Fuel) to the nearest gallon by dividing colunln C by column D. 4. Space is provided for ten vehicles, if more are operated in Wash, use Schedule I (Supplement). Supply is available upon request. SCHEDULE 2 - DETAIL OF WASHINGTON. FUEL RECEIPTS (Service Slalion Receipts Only) INVOICE SELLER DATI HUMin NAM. LOCATION .. f ::. '. . i....... . .. .. J' ~ '.\ '. TOTAL WASH. I.D. NUMBER GALLONS INTO VEHICLES SCHEDl".E 2 - INSTRUCTIONS J. Washinglon purch:uc Invoices in detaU must be listed by each vehicle. 2. The gallons Iisled for each purchase invoice should be carried to the nenrest whole gallon, Use even gallons--do nol show Itnlhs, :.' . tit !'" . ," ""',':' "".'. ':,.,' ';"". ' I"." , , i'.,: ~; ,co' :. ,';-, .....',. : ...,.. I ;.';.,: :. ., :" "', . '.:: . :. '.,. ;".': " .' . .. ~ . . . '. ,~,' '.'. . ',' . :.' :;);:':\i{;;:~:~:~1 ::'::"..':: '.>::. ': :. : ".:' , ,,:..;\: . ".: .: ,~ :'. >: . ..... ~,,> .' .. . . . " , . , .< ". : . ~:ffii[1 ... . '. , .,., ..... " .,' .' '.',. ,,'.'.:. ,..' .':'.' . .'. . . DEPARTMENT OF MOTOR VEHICLES LIQUID FUEL TAX DIVISION . STATE Of WASHINGTON ..: .'. USER'S USE FUEL TAX REPORT For State, Counties, Cities, and Urban Passenger Transportation Systems . Name.................................................................................... .... ..........-.......... Permit Number.......... Address..... ...... ... .., ...... ........ ... ..... ...... ........ ................................ ......u. ... .On. '...... ,,, ...".. Month....., h. ,,19.......... STATEMENT OF TAX DUE THE STATE OF WASHINGTON FUEL g -1___ __ I $ 1. Used on Washington Public Highways (Total Schedule I, Column E) 2. Exempted Use for Highway Construction and Maintenance 3. Exempted Use by an Urban Passenger Transportation System 4. Balance on Which' Tax Is Due (Line 1 Minus Lines 2 and 3) TAX, PENALTY, AND INTEREST 5. Use Fuel Tax (Line 4 @ 9t) '6. Penalty (10% of Line 5) 7. Interest (Y.z % of Line 5 per Month Be"inning on the 21 st) 8. Total Due for the Month (Lines 5 to 7) 9. Other Debits or Credits (Explain) 10. Remittance Payable to State Treasurer $ i $ .. .' SCHEDULE 1 - COMPUTATION OF FUEL USED ON WASHINGTON PUBLIC HIGHWAYS VEHICLI IDI!NTlflCATlON II 101 MILES TRAVElED WMhlftlt_ L1~"'I' H:':"::" N"",", k!CItlng c:r:~:)' TolOI W..hlnllt.,. P"bll~ Hlghwll)'5 ICI foral G.II_lof fllel Uled Gallon. of ,.,,1 U.ed on W.I~~\'.:'~"bIlC I'J A....rGII. Mil.. p., Gollon IAI (II TOTAL =-ir===1 -~ Submit report with remittancc 10: Stale of Washington. DepaMment of Motor Vehicles, Liquid Fuel Tax Division, Olympia, Washinglon. If lnx is nnt paid on or beCore the 20th day of the month, add penalty and interest Cor delinquency as prnvided by Rcvlsed Code of Washinglon (RCW) 82,40.080. o Check here iC this is a final report nnd enclose u,. fuel tax permit and I. D. Cards. I, bdnll dilly' Qlllllo,;:td. hereby <,erlily 11101 IlIis ,eflort i" /0 Ihe be,,, 01 my knowledge Irlle, correcI, and <'(lmplett ill a,'<,ordance ",ilh chapler 82.40 RelY and appll<,able ,ellulations. ,'.,' ,,. . .... .. "'. " .- ~I:- . .... .....,.../ . ......... . ". .... . '."....' i."'" , ........... '. ~ . '..: . ..', ~ , ~ .. ",' I":; ~ !!: .. ,','''.i:, Signature ... .. ......~._....._..h'. .. .... ..~~.~..n.....__. "".._....u.~.......~.... Date... ...."................,........ ..".. .........." 19.......... DOlted nL....... ......................, TiUc.._..__...._.. "'" '__m ................ Form No. UF 507 J'> ',,,;....'....'~.' .. .. . """". "',' ..:.... '. '::" ,.' :"'.:"'.' ': "::><' ,';. :.,; :,' . .. ~" ::'; ," . '.' . ......, :: .,' ',...::"';'; ',,' ....' .....,.:.;.: '" :' ,'......' '. ...:':":" ': :.... ..,.,;:. - ;j};' .< , ,.... '.' .,', . ,'. ;",';: ,:": :' ..~' , . ....... ....:.. '. . ..... . ..... ..... " ~. '.... ., . '..., --, :~> . ....., . . . .' ,'" , '. ,..' ',;,: ';: , ..'.. I . . "~"". .... ,'. '. .. .. '. r., ',' SCHEDULE 1 - INSTRUCTIONS 1. List each vehicle for which a Washington I. D, number is required. 2. Compute column D (Average Miles Per Gallon) to two decimal places by dividing column B by column A. 3. Compute column E (Taxable Gallons of Fuel) to the nearest gallon by dividing column C by column D. 4. SRace is provided for len vehicles, if more are operated in Wash. use Schedule 1 (Supplement). Supply is available upon request. SCHEDULE 2 - DETAIL OF WASHINGTON FUEL RECEIPTS (Service Station R~ceipts Only) INVOICE SELLER WASH. I.D. NUMBER : ""TI NAME LOCATION HUMI" ", , . TOTAL GAllONS INTO VEHICLES . . ,,'. .:' . ,:",.':,' " ' .'. , '.,,' .., , ,: , " " I i ,:..' ." : : ." " ' \! :: " SCHEDULE 2 -INSTRUCTIONS 1. Washington purchase In,'olces in detail must be listed by each vehicle: 2. The gallons lisled for each purchase Invoice should be carried to the nearest whole gallon, Use even gallons-do Dol .how lemh.. . . ,"" ~I',"::" " ' . '. , (i;" ',:~' , :', ' w~::~CI,,:, '. ",''""'~''~~ " , , ' . ":""" , '" ""..'! ,.:::':,. , ',,' " <," " " """. ... .. :. ......... . '>:', .' ...... .:. .... ...:.,.< >.::..... .' :','. '. . ". . " :. ..'- ..,....:.. . .... :. :; . "<. '. ... . .... :.... .. ". ;. . . STATE OF WASHINGTON . DEPARTMENT OF MOTOR VEHICLES J.I0UJD fUEL TAX DIVISION USER'S USE FUEL TAX REPORT For State, Counties, Cities, and Urban Passenger Transportation Systems .......... Permit Number .... Namo.. ...n'" ..n........ .un ........ .... ........... ..... ....... .... ..............................-. ... .... ....., 19.......... Address. ...........................................................................................-.............. ... Month..... STATEMENT OF TAX DUE THE STATE OF WASHINGTON FUEL ~I ~cw~. ~ 1. Used on Washington Public Highways (Total Schedule I. Column E) 2. EXempted Use for Highway Construction and Maintenance 3. Exempted Use by an Urban Passenger Transportation System 4; Balance on Which Tax Is Due (Line I Minus Lines 2 and 3) . TAX. PENALTY. AND INTEREST 5, Use. Fuel Tax (Line 4 @ 94) 6. Penalty (10% of LineS) 7. Interest (v.. % of Line 5 per Month Beginning on the 21st) 8. Total Due for the Month (Lines 5 to 7) 9. Other Debits or Credits (Explain) 10. Remittance Payable to State Treasurer I I $ i $ $ SCHEDULE I_COMPUTATION OF FUEL USED ON WASHINGTON PUBLIC HIGHWAYS VIHICLI IDINTIfICATION 1\ IAI "1 MILlS TlAYUf:D Avorag. Mil.. p" 00110" Oallonl.f ,,,,,I U.ed_ w,,~~..::.,:ubllC "1 'olal Gallon' ., 'uol U.ed hollrlg C:ri~:' To.ol Wo.hlrlgt_ Public Highways lei 'W....IIIft. Lie..... N~' H",~' ,DI I - I I ,~~ I I . : I \ TOTAL I ~ " . . . .'.. . . . . .... .......:. ... . '. ".:'. .'. ..' ..' :.' ~I:)' ". . ...... .... " . . '." ... .". '. .'. .. .. :.....'<..: ' . .... .' ......... :.: . :' Submit report with remittance to: State of Washington, Deportment of Motor Vehicle., Liquid Fuel Tax Diyl.ion. Olympia. Washington. If tal< i. nnt paid on or before the 20lh day 01 the month, add penalty and interest lor delinquency a. proYided by ReYised Code of Wa.hlngton (RCW) 82.40,080. o Check here if this is a final report and enclose use fuel tax permit and I. 0, Cards. 1. hr/ng (1lIty mlllwrlzrd. IJ~rtb.v ctrli/y Ilral Ihl.f rtporl i.f to ,"r be.u 0/ my knowledge Irllt, correct, and ce'IIII,ltte /11 a<'Cort/anct 11'1", clla,'/" 8~.40 RCII' alld a"'l/koblt ,tgulat/om, ;.; : n ~ ,.... '" :. ;' ~ ~ ~ .' Signature.. . Title.__....... ." Dale.. ." .. .... ............ 19"".. ". D:lterl ,. Form NO. UF 507 ... ,.., .:>: ':..: .'.... :,. .:". :'. ". .' ,;.. . ::'." c,." .- ':i. '. ''':'' '.. 1:"""':1':;';' ....:... ~ '. ., ,.:' . .: ',' . . . ':":.\" .<: . : ..... DATI NUMIU NAME LOCATION WASH. I.D. NUMBER GALLONS INTO YEHICL!S ~ . ' ". ~ '~: ". . ....... .'.' . , .,,' '.,.' . ".:' "..' ~"'::::':"':'.: '1 "":;" ' . . ".. '. '. ."0 ;,; .. ,::.'. ":'" .,', .' , " ,", ,.:', ,'.. [.:',.,:.,;, : "" . , . . . . ,> " '.,' '. " :'c'.:.. .' : .::...., ..' ,..... :.,.: .......: " ".: ,.... .... ".'. ..':', '.....' ,.~:. . . 'i SCHEDULE 1 -INSTRUCTIONS 1. List each vehicle for which a Washington 1. D. number is required, 2. Compute column 0 (Average Miles Per Gallon) to two decimal places by dividing column B by column A. 3. Compute column E (Taxable Gallons of Fuel) to the nearest gallon by dividing column C by column D. 4. Space is provided for ten vehicles, if more are operated in Wash, use Schedule 1 (Supplement). Supply is available. upon request. ,:, , . ," : SCHEDULE 2 - DETAIL OF WASHINGTON FUEL RECEIPTS (Service Stalion Receipts Only) INVOICE SELLER .'.....:,: ":', . , . , ,> '" ,;,".;, ,.; ,/ " ,;'t '; .' . \ TOTAL ':' . . I(\~; y,:,: ~~fi' ...,'", .( SCHEDULE 2 - INSTRUCTIONS I. WllShington purchase invoices in detail must be listed by each vehicle: 2. The gallons listed for each purchase invoice should be carried to the nearest whole gallon. Use even gallons-Jo not slrow ten/Irs. "" ", .;,::'c,: :..: :: ' ":'1<', :.,', , :,::0.., .... .,1, .' ,'.' , :', '....', ".',' :',/':':, . ;;.1Ii .,"'" "', , . , '.' , ~~~l~~~G?'pNJ . " :' ,'..": _"C,;' :':..:", "" '.,' ,:."..'. '.' 0" ,.':' ' '.', ".' :,..',' , ",' ..... : >'7' ....:.. i'i i.'''',: .' ,. .. ~;i;/", ......'."> ,{;; if;..... :,!,i "i ,:...i ... ....i......................... "",'. .". .. "i .,ii": :".: .' ..i"i'.' .... .i.....i. > ',.. .:....... . ....< . ii,.... .... .',.. ..' .... ..,:. ; . STATE OF WASHINGTON . i.. ,., ,. .:;....,..., .; DEPARTMENT OF MOTOR VEHICLES LIQUID FUEL TAX DIVISION (.: ., USER'S USE fUEL TAX REPORT .,.. ?( For State, Countios, Cities, and Urban Passenger Transportation Systems Name...............................................................................................-..................-.. ..... __................ Permit Number............ ............. .... Addressu. u u .uuu. u.. .;.. uu U. h..m ..........................................................-............'. uu.u uuu. Monthuu. -....... ........ ......,19..... .... STATEMENT OF TAX DUE THE STATE OF WASHINGTON FUEL ~ GALLONS l. Used on Washington Public Highways (Total Schedule 1. Column E) 2. Exempted Use for Highway Construction and Maintenance 3. Exempted Use' by an, Urban Passenger Transportation System 4. Balanee on Which Tax Is Due (Line I Minus Linos 2 and 3) TAX. PENALTY. AND INTEREST I --_.. -- 5. Use Fuel Tax (Line 4 @ 9t) $ 6. Penalty. (10% o[ Line 5) I . 7. Interest Ph % o[ Line 5 oer Month Beninnin. on the 21st) i 8. Total Due [or' the Month (Lines 5 to 7) $ 9. Other Debits or Credits (Explain) 10. Remittanee Payable to State Treasurer 1$ , SCHEDULE 1 _ COMPUTATION OF FUEL USED ON WASHINGTON PUBLIC HIGHWAYS VlHICU IDENTifiCATION II hlal MILES TlAV!UD Gallon. .f Sealing AVI,ag. '1,101 UHCI Oft Capoclt, Gallon' .f hlal Wo....ln.ton Mil.. Wadt~ill~:~bIlC .....a..... L1eet'l.. .r'III 'u.1 U'H '",bUc p" Gallon I. D. HighwaY" "_ Nil"'"' '" I" '0' '01 I" I , I I I I TOTAL l Submil report with reminance to: State of Washinglon. Dopartment o[ Molor Vehicles, Li~uid Fuel Tax Division, Olympia. Washington. If lax is nol paid on or before the 20th day o[ the month, add pena ty and interest [or delinquency as provided by Revised Code o[ Washinglon (RCW) 82.40.080. E o Check here if this is a final report and enclose use fuel lax pennit and I, D, Cards. = r;; I, heillll ,III/.v "w//Oriud, heuh>' rertily ,hat thl. uport is '0 the he., <>1 my knoll'/edge true, correct, and "'. ""'lip/ere ill arrordanre lI'i,h chapler 8:1 .40 RelY and allplir.hle {'e/lll/atians, '" Signnlure .' . UP ...-.... .......n.........- . .....n.......... Date. .................................. ...... ............19.......... E :; , T1t1e._.._.... .... Dated at......... .....--......--........................... ...."...... .......... .-..... ................ .......n... .n..._.... ............. ...............;\\:...... . .'.",' .., ,'. ,.,'. :" . :;;:. .....<, " .......' <i. ".':'., ....:...,. :. 'i i,'". i',:" ':::. i; .....", ..i i, :, 'i,...:.........:. "'." ".'" ;./i....i' : . , '';eli.. ..... I ,~ '."'",,. " '" ." ". .' '. .;':.,' '. ". , '.' ;,. :'. c, '" ......', ,'.'. . . ~ ,):~;~ . " . " . . . . " '.. ,.' : . " - '. ~ .' I; ;,,, ,':"- I;, ".', .. ........,...:, .'.; : ,".c. ': i,' '.; '.;.. ...: , .':. "'" .. SCHEDULE I _INSTRUCTIONS 1. List each vehicle for which a Washington 1. D. number is required. 2. Compute column 0 (Average Miles Per Gallon) to two decimal places by dividing column B by column A. 3. Compute column E (Taxable Gallons of Fuel) to the nearest gallon by dividing column C by column D. 4. Space is provided for ten vehicles, if more are operated in Wash. use Schedule J (Supplement). Supply is available upon request, SCHEDULE 2 _ DETAIL OF WASHINGTON FUEL RECEIPTS (Service Station Receipts Only) &.OCATlON WASH. I.D. NUMBER GALLONS INTO VEHICLES . ': INVOICE SELLER CATE HUMin NAM' " ,; ': :' c . , .' :; :\ TOTAL SCHEDULE 2 _INSTRUCTIONS 1. Washington purchase Invoices In detail must be listed by each vehicle. 2. The gallons listed for each purchase Invoi"" should be carried to the nearest whole sallon. Use even gallons-do nor show renlhs. . . ...~ \ '< ... ..'. ~<:", : ," ::'" , 'J':",::: "'..,,; ", Jfq.,:,,; . '.' .'.' . ;:'.:....,.. .' . '.', , .' '" . .."....,., , , ,:; f(-".", I.) ~;>; ,.','.,. '.".,' ,':': :'" :' . .':::" ;. ..:.iIl 0 . g .2 " "8 " -= ] ~ -a c '" '" 0 0 on 'i .c E 1 c t -g ~ m " c 0 -g > ~ ,2 ~ u 0. " ~ W i ~ ~ J! ~ 0 .1 0 ~ ~ ,- ~ 5 E ;S ~ ~ ::> " 0 .2 . -= c E . " g> > W .2 0 ~ .c :g - :I: ~ " .... ~ .c .c '0 ] E ~ , Z E E ~ 15 u 1 .g s < .g .g ! ,.. ~ >; . >; :I: c '0 " " .... " " ~ . 0 .2 E '" E E U .2 ,.. W >- >- 'i c ~ " .<l & :I: .., ~ 0 ~ .c . .... .., ~ ~ g 1 -g " >; 0 -g 1: ! 0 .E ~ -g '" l3 -g ~ -g "" '0 '0 c D E- o ~ D D 0 0 ~ . c -a -a " " ~ ~ -a Z I 0 c ~ . 0 0. W 0. 0. Z 0 1 u ~ > ~ ~ " ~ ~ c > W ~ ~ ~ " ~ Cl ~ > ~ > J! oS ~ 0 .2 0 " z " I " w 0 " E Z j " .c c " '8 "8 "8 ~ u ] > W .c " '0 0 ~ 0 '" ~ '" - ~ .2 .. 1;- Cl .~ 1: " ~ >- >; ~ 0 -a " ] '" .... e ,; ,; ~ .c 0 ~ ~ c ,; :?; c Z c Z => 'j ~ E .., ~ ,51 Z ,51 .J! .g g E " :I: ,51 e . " . u. 8 D .! 'li u 'li ] 'li ] 0 . ~ " " ~ .~ i:'i ~ . ~ . ,.. , " 0 .c .... 1 oS .... ~ 'j .5 >- ~ ~ z i e u ,.. '" c c .2 i .., c 0 0 w " ~ -g .c 0 C ~ .c e (/') 0 c ~ W e z ~ E . 0 '5 ~ >- l;:j >- ,.. 0 ] 2 E J! .., ~ .., .., u 1 ~ .c ~ ~ -a 1 1 > ~ ~ '0 i 0 " )..:i: '0 -g , u 0 .., c " ,. 8 8 8 ,~ ." ~ 0 .c 1 W '6 1 ~ " '" " " "5 .. 'Co ~ .... u u . " '" 'i I~ 'i 'i ~ .2 ~ a '~ ~ 0 0 0 1 " i ~ " ~ 0> . 1 -g '~ -= ,5 of 1 " - ~ ~ '0 15 0 .., 0 .c 0 ,~ ~ E IW -= -= -g c g 0 . .E '" , ,.. .c ~ !Z ~ ~ c 0 ~ .l! .., - .~ '" ~ 0> E -g ~.~ W ~ 0 .c c ~ " .." 0 ~ l ~ >- >- ,.. -g .c 41 0.;: .., < .., 1 - c 0 ~ j ~ .5 .~ ~ o 0)-:: .... " >." Q. ,- '5 D .! '" .c ;: . 0. '" W c." 0 -a -= :I: &. ~ If C C .... ~ E ~ ." " .3 0 ~ t E . STATE OF WASHINGTON ,.. " DEPARTMENT OF MOTOR VEHICLES UQUID fUEl. TAX DIVISION USER'S USE FUEL TAX REPORT ~or St~te,. Counties, Cities, and Urban Passenger Transportation Systems Name............................................. Address.... ....................................................................nn.................-- Month STATEMENT OF TAX DUE THE STATE OF WASHINGTON FUEL 1. Used on Washington I'ublic Highways (Total Schedule I, Column E) 2. Exempted Use for Highway Construction and Maintenance 3. Exempted Use by an Urban Passenger Transportation System 4. Balance on Which T?-_x Is Due (Line I Minus Lines 2 and 3) TAX, PENALTY, AND INTEREST 5. Use Fuel Tax (Line 4 @ 7'h~) 6. Penalty (10% of Line 5) 7. Interest (112 % of Line 5 er Month Beoinnin on the 21st) 8. Total Due for the Month (Lines 5 to 7) 9. Olher Debits or Credits (Explain) 10. Remittance Payable to Slale Treasurer ~ -.c..J'-- I I $ I $ $ SCHEDULE 1 _ COMPUTATION OF FUEL USED ON WASHINGTON PUBLIC HIGHWAYS VIHIClI IDIN'IPICA,1'I0N S.atlnll c:ri~:" 1\ To'.' I Gollo"' .f f..." U,MI lAI '~ j MILlS TIA-VILED W'tIO~'''' Llcenlo NvltlH' N..","" IDI GClllon. of fuol U.ed on Wal~rll~~ubIlC III 1'1 Wo.hl"lton "'bile Hl,hwo)"l lei AVIIG'. Mil.. per 00110" Tolol II lI------.-lr------:: II F --r-:=.-..Jr--= ---, ------11 ~ -- -11------>, II II ~ tOTAL SuhOlit rcport with reOlitlanee to: Stllte nf Wllshinglon, Department of Motor Vehicles. Liquid Fuet Tax ~ivision, Olympia. Washin~tnn, If tax is not paid on or before the 201h day of the month, add penalty and interest for delinquency as provided by Hevised Code nf Washington (HeW) 82.40.080. o Chee\; here if this is a linal report and enclose use fuel tax permit and J, D. Cllrds. I. "rillg dilly flwllOr;:rd. /rnrby c"rrli/.\' ,hat this rt'rort i,1f 10 ,ht' h~.f' 01 my knmdtclge true, correct, and rOlliI"l"!' ill lll'L'ordmKt willa ChOl'ltr t~~.40 nelY lmd applicable rtgular;vlIs. n ~ ~ :;:. Si~ni\turc Date ... _, 19_ ~ ~ :; Tille............ . Dated at '::"'::}: ... ,;" .- ....... :...... ': ", '. .; ..~., , ,', '.,'.',' . , :. "'.<.,'." , '.,',., ,,' .'," ;-. ''c.: ". : SCHEDULE 1 - INSTRUCTIONS 1. List each vehicle for which a Washington I. D. number is required, 2. Compute column D (Average Miles Per Gallon) to two decimal places by dividing column B by column A. 3. Compute column E (Taxable Gallons of Fuel) to the nearest gallon by dividing column C by column D. 4. Space is provided for ten vehicles, if more are operated in Wash. use Schedule 1 (Supplement). Supply is availabel upon request. : SCHEDULE 2 - DETAIL OF WASHINGTON FUEL RECEIPTS , (Service Station Receipts Only) .< " INVOICE SELLER WASH. GAllONS I.D. INTO DATE HUMin NAME LOCATION NUMBER VEHICLES '. " , .: ,'. '; '. I . TOTAL ; SCHEDULE 2 - INSTRUCTIONS I. Washington purchase involccsJ,n deJiI must be listed by each vehicle. 2. The gallons listed for each purchase ~ voice should be carried to the nearest whole gallon. Use even gallons-do not slrow lemlrs, . . ..,,-... ", . .' "", ':'. 'I,": ,',,":'''':',:: " .,..1 1 ""- :.,'<,:c.' '>:'. ". . ....' '. . .' ..:.... .'. >." ,'<",..,.,:::.\ 'r" f .~ . : i.:' .'] ;,; ..:>::.,. SCHEDULE 1 -INSTRUCTIONS I. List each vehicle for which a Washington I. D. number is required. 2. Compute column D (Average Miles Per Gallon) to two decimal places by dividing column B by column A. 3. Compute column E (Taxable Gallons of Fuel) to the nearest gaUon by dividing column C by column D. : 4. Space is provided for ten vehicles, if more are operated in Wash. use Schedule I (Supplement). Supply is availabel upon request. SCHEDULE 2-DETAIL OF WASHINGTON FUEL RECEIPTS (Service Stalion Receipts Only) INVOICE SELLER WASH. GALLONS I.D. INTO DATE HUMin NAM' LOCATION NUMBER VEHICLES .. - - I i I -- TOTAL ! SCHEDULE 2 - INSTRUCTIONS I. Washington purchase Invoices in detail must be listed by each vehicle, 2. The ga1l~s lislCd for each purchase invoice should be carried to the nearest whole gallon. Use even gaUons--do not show lenths. . . - ." ,'..' " :c;'i,,, :/.' , I,:,::.. : "':,:,:,'::', " "" ':' :',::: " ':.""~':. .:' "', :, . , ,:: ' ' ":; ,: ','.' , ,'" :, ,," ""<" ,i.' ' ',', '" .:, ' , ,:,.,' , ", " '," ' "",.',,', " , ' ',':,:" '" " :" ":" '/': "',,, " :: ;' ",' ': '" .' .", ,.' :',' , SCHEDULE 1 -INSTRUCTIONS I. List each vehicle for which a Washington 1. D. number is required. 2. Compute column D (Average Miles Per Gallon) to two decimal places by dividing column B by column A. 3. Compute column E (Taxable Gallons of Fuel) to the nearest gallon by dividing column C by column D. 4. Space is provided for ten vehicles, if more are operated in Wash. use Schedule I (Supplement). Supply is availabel upon request. SCHEDULE 2 - DETAil OF WASHINGTON FUEL RECEIPTS I (Service Station Receipts Only) INVOICE SELLER WASH. GAUONS I.D. INTO DATE HUM.EI NAM. LOCATION NUMBER VEHICLES - ; , , , - I -- , I TOTAL : SCHEDULE 2 -INSTRUCTIONS I. Woshington purchase invoices in detail must be listed by each vehicle, 2. The gnllo~ listed}or each purchase Involce'should be carried 10 the nenrest whole gallon. Use even gnllons--do not show tenths, . . , '''''' : " ,:"': , , ' " :":,',:i,':;';:', \'::"'::' ' ':," ,,1;,( 1.......... I ~~ UF 971f . . STAlE OF WASHINGTON DEPARTMENT OF MOTOR VEHICLES LIQUID FUEL TAX DIVISION For State, Counties, Cities, and Urban Passenger Transportation Systems ::::tif:~'~~m~~.. .,.............. USER'S USE FUEL TAX REPORT STATEMENT OF TAX DUE THE STATE OF WASHINGTON ___ Permit Number_f;j'~-~:?---- _~-.__.19~b I GALLONS FUEL 1. Used on Washington Pu~lic Highways (Total Schedule 1, Column E) 2. Exempted Use for Highway Construction and Maintenance 3. Exempted Use by an Urban Passenger Transportation System 4. Balance on Which T~-" Is Due (Line I Minus Lines 2 and 3) TAX, PENALTY, AND INTEREST 5. Use Fuel Tax (Line 4 @ 7~~) 6. Penalty (10% of Line 5) 7. Interest (~% of Line 5 on the 21st) 8. Total Due for the Month (Lines 5 to 7) 9. Other Debits or Credits (Explain) 10. Remittance Payable to State Treasurer ~ ",-- I I $ --j $ $ SCHEDULE 1 _COMPUTATION OF FUEL USED ON WASHINGTON PUBLIC HIGHWAYS V1HICU IDlNllflCAflON S.olinlil 1\ lolal MILlS TIAVELlD Gallon. of Av.rage Fu.1 U..d on C:ri~~)' Galhm. of WOlhlnllt... Mil.. wa'~~D~;o~ubllc Wcnhl...,.. Linn.. fu.1 U..d hlal P",blll: P" 00110" I. D. HI,hw..,. N_ber H",,,,"' IAI 1'1 lei 1'1 1'1 ,'- i ~~-= ,: -- -------j ----1\1 -----===\'11 TOTAL I ~ Submit rep(lrt with reminance to; State of Washington, Department of Motor Vehicles, Liquid Fuel Tnx Division. Olympia, Washinglon. If lax is not paid on or befnre the 20th day or the month, add penalty and interest ror delinquency as provided by Revised Code of Washington (RCW) 82.40.080. o Check here if this is a finat repurt and enclose use fuel taX permit and 1. D. Cards. I. being I/UI.\' (1II11IOri:.ed. "~'eb.\' certify ,IIat this rt/Jn,t i,r to 11r~ heM 0/ my knowledge true, correct, and compltlt: ill an:c"J'lIIc(" 1\';,11 c/I(ll'lrr 81.40 RelY ami applicable rt>RulatiotL'i. Date ____ _, 19._ n 1; = ;:;; ~. ~ ~ :; Signature .'" .' I, ,1 :.'., : ',', " . ,," ' ,',,:';, ,.,";. ,,'.:, '." , ". ". ~. " ",., '''',. .,':, :' "",'" -/ " .,,~ I',,, : SCHEDULE 1 - INSTRUCTIONS , 1. List each vehicle for which a Washington I. D. number is required. 2. Compute column 0 (Average Miles Per Gallon) to two decimal places by dividing column B by column A. 3. Compute column E (Taxable Gallons of Fuel) to the nearest gallon by dividing column C by column D. 4. Space is provided for ten vehicles, if more are operated in Wash. use Schedule I (Supplement). Supply is availabel upon request. I SCHEDULE 2 - DETAIL OF WASHINGTON FUEL RECEIPTS (Service Sial/on R~ctJpts Only) INVOICE SELLER WASH. , GALLONS I.D. INTO DATE HUMin NAM. LOCAHON NUMBER VEHICLES - I I TOTAL SCHEDULE 2 - INSTRUCTIONS I. Washington purchase Invoices in detail must be listed by each vehicle. 2. The gallons listed for each purchase invoice should be carried to the nearest whole gallon. Use even gallons--do nor s/row rem/rs. . - . . 1"""1 I";,,,~~,,"\j: ': ,",,',-',' "':">',' ,1,',1'..::"":' ,',,',' I ........ .,.'".;, . ' , ' , .:., ..'., :;';''-'' ':' , :' ,,,'" ":', ".' '...'" ' :,,::", ,.,'.' :;:' , .'., ,,';; , .:;. .' " ''.: " " : .', c' ': .- ,< , . ',. ., ,. , ',', ,',:, ,,:: SCHEDULE 1 - INSTRUCTIONS 1. List each vehicle for which a Washington I. 0, number is required. 2. Compute column 0 (Average Miles Per Gallon) to two decimal places by dividing column B by column A. 3. Compute column E (Taxable Gallons of Fuel) to the nearest gallnn by dividing column C by column D. 4. Space is provided for ten vehicles, if more are operated in Wash. use Schedule 1 (Supplement). Supply is availabel upon request. SCHEDULE 2 - DETAIL OF WASHINGTON FUEL RECEIPTS (Se'~;ce SIal/on Receipts Only) DATE HUMin NAME LOCATION WASH. I.D. NUMBER GALLONS INTO VEHICLES INVOICE SELLER " TOTAL SCHEDULE 2 - INSTRUCTIONS 1, Washington purchase In,'oices in detnll must be listed by each vehicle. 2. The gallons liMed for each purchase invoice should be carried to the nearest whole gallon. Use even gallons-do nor slrow Itntlrs. .. ~. . I ',' :'. ;' \<'i:i' ;',-, :''':':'':', ::" " ' ,,":,' ' ': , .":,',"'.:; ,:, ," ,,',",', " "::, ',.' \'.. ,.", , ':;-':'/', 1,:<;, , L ,,~ ~ ., ""'" UF 97B .~ STATE OF lIASRIIIGTlW DEPAKTIIEIIT OF LICEIISES LIQUID FUlL TAl DIVISION User's Use Fuel Tax Report FOR STATE, COUNTIBS, CITIBS, AND URBAN PASSENGBR TRANSPORTATION SYSTEMS Neme ......../k/r......t!4..'.~/-I.:....f.....~k~J................permi t lIumber ..I.~~..... Add re. ...l..f.2.:L...............::.................................................................Month.......:fl...................., 19.tf?'6 STATEI/EIIT OF TAX DUE THE STATE OF WASHIIIGTOfi FUEL 13.110.. 1. Used Oil; WaablDrtoll Public "l,h",.,. (Total Scbeduh 1. ColulTID 81 2. RZer'lPted Dill!' for Hirhwa, CODIJtructloD aad MaiDleD&cce 3. KJ:emptl!'d Dee bJ' aa UrbaD PaS8ea(er Trusportatioa STat em /~ /d/.( .. B&lnce on \'hleh tn Is Due ILhe 1 Hhu Lhes 2 aDd 31 ,..-() .-/ 'U.X, PEIlALTY, AIID IIITEREST 6~ IIse Fuf'!' Ta. (Lhe of. @ ',*,) 6. hal'llty 110' aI' the 61 7. htl!rest 161 of LillI!' 5 p...t' Hoatb Bep.inaiDIl .~D th.. 21stl 8. Totat Due for Ule Iloatll fLiu!'! 5 to 11 9. OUer Debit. or' r.redlt~ (Ez lain I . 10. Rern1tua~~ Pay~b1. to Sute Treuurer SCHEDULE 1 - COMPUTATION OF FUEL USED 011 lIASRIIIGTOfi PUBLIC HIOR1IAYS VR. I CLR .,----- H"-'. UVRLRn I I Gallo.. of WublDrlOD SeatiDr Total i WasbhrlOD A.erale P.el O..d oa Zlnbtf'fl'l Li C.D Ie' Capac:i t1 I (jalloDs or I Total PubUc HU.. y..Ia. Poblle .KDmber t'hu'Iber of Bus Fuel Used "I Hi,h,'C&111 p.t GalloD Hl1th,;:'" ... I tDI . - ..__._- -- I ...- , I , - _. r- I .- f! I .-- -- TOTAL ! SUDrtlit report wltla rftlli Haflelt to: r;;ut. of "a.bill' \011., D.partl'l.Dt of Lie'DI", Liquid ,..1 Ta. Dhhiol, OlrmPI.. V...UII,tO.. If tal 11 110 t pal d 011. Ot btfor. tilt IOtb da1 of the I'lOlI.tb, add PlDalt, I8d i.Unlt tor deU''lluer III pro"14'4 b1 ,."1nd Codlt of "&lhh,\o, 'PCWI ".40.080, 0 Cllell lit... 11 'Us h . fi.al uport &ad ..clo.. I lit tul tax p,""tt. lid .,..bl"".. I 1. 601"1 dul, "'1~..I..d. I.r.b) ..rll/, c,'.or cM, ..,(to"c (.t 10 I^. HJl 01 ., ......I.d'. ,~, COf'V.e', """ .oe;I.,. (" occor:l4llc, ."',,, ('%a~I'" 113.UO lell A'lJ attf)Uc:abl. 't'fulcctOtlJ. I I', II. t.. 'e.. ........... ........ ...... .... ............,............................ .......... O.t<<....................."".............., , I' .... TI.l......................"........................,......... .............................. Dlt.d .,............................................. " ~ . "r-~,1"rn!J'.r,"'"mlo..~w.- '~~'~I~^'" r.'~l""~'.I1'''-l1.~' ,""'-"",\""'''' "1"'''''''''''-''''''<-'''.,,,,,, '...~..,<'F.~. .." .""''''',..~.,'''~.,!C.,'"..,"''''''''-,;..;;,,..,~ ';l ,~jJII/jt~~~"~IlII~i)i.!YAh;~~2j;j,01'~(:~llifA'':l\,IM.'.I:'.,,,\C')il.'''''NWNiiti.'cj.,.l",...,\\ .~l"".,(,',\'I,'~'l''''lg'l; ,ll..",.,l',,"""''':''~'.'I,,~I:i''MW:;~';'''4,~'!11;,iff,!~:J ...... <(;,?1I[> :'~/;;:;';,< >;i!::'~;:"';"~~ ,:~,. :.:. -- ,: : .:. ".. . " . ')?i~~~f . '. . " '. .'<",.L I,. .' ~ ' .,'.. '. ::'. . .' -':, '" .. . .: ".." , .::.. .. . . .'. . '." . .. :'..,. :.... ": '. '. . -,' I. ~ . . . I'., . .. ,'. ~ .:...'.. . '. . .. .:" ,:,: .. . . :~". : '. .:. :.: ", .' ':: . .... .. ...... . ..:' . :.., SCHEDULE I__INSTRUCTIONS 1., List each vehic Ie for which a Washington euhlem is required. ~: ~: ~~t~: ~ ~~:;bt: ~ii~~!1-~i)) t~Ot:on~:~;:l Jli:\~Ydt~i~~:gc~l~:; cBb~Yc~l=D~. 4. Spsc'e V. provided tor. ten vehicles t if more are operltted in Wash. use S:hedule 1 (5Jpplenent). .supply is anilable upon request. - SCHEDULE 2--DETAIL OF WASHINGTON FUEL RECEtPT:S (Service Station ReceiPts OntvJ SELLEP. NAME LOCATION WASH. EMBLEM NUMBER j;J.,.-d,!. GALLONS INTO VEH I CLES .'---, .'. " . .' , : .. ; .... ", ':".'., .... ," '. " '. i :" ': !':';. '..': :,:" .'. " .' > ' ,,' " TOTAL "".' ': , :<r .,. SCNEDULE 2_.INSTRUCTIONS k ~:Tt:'~~~:d"(:v:~~ ~r.~~i~~~e~h~ir~b~.~~i~d\'~~i~t'~.N!.t whoht Rftllm. Lkae II""" fP'llm...do not,hoe tenths. '"" ':' " , ,':: '" ::':' ',~ ':'.::"':>; ",', ' '" ,'., .', ,P ',' ::' , " . "." '.:" .:", ";',:,'.1, ,:.. , .. fl~ ~....,. "",: ': " ',: ,:"'.... ",':: .:',' . l~' ,,,' ""-- "' UF 97B . ,.I ~.;11114- STAlE OF WASHINGTON DEPARTMENT OF MOTOR VEHICLES UQUID fUEL TAX DIVISION USER'S USE FUEL TAX REPORT For State, Counties, Cities, and Urban Passenger Transportation Systems Name...........................................n .-.... .............. Permit Number.. Address.. ................... ................ nn. Month.un , 19n(..k STATEMENT OF TAX DUE THE STATE OF WASHINGTON FUEL ~I;~ I / - . ~ -:-l-':::::::::"I I I $ I J. Used on Washington Public Highways (Total Schedule 1, Column E) 2. Exempted Use for Highway Construction and Maintenance 3. Exempted Use by an Urban Passenger Transportation System 4. Balance on Which Tal' Is Due (Line I Minus Lines 2 and 3) TAX, PENALTY, AND INTEREST 5. Use Fuel Tax (Line 4 @ 7~O 6. Penalty (10% of Line 5) 7. Interest (~% of Line 5 on the 21st) 8. Total Due for the Month (Lines 5 to 7) 9. Other Debits or Credits (Explain) 10. Remitlancc Payable to State Treasurer $ -"'- $ --'" SCHEDULE 1 _ COMPUTATION OF FUEL USED ON WASHINGTON PUBLIC HIGHWAYS VEHICLE IDlNTIFlCATlON MILlS TlAVEUD Oclllon. oJ S.al;ng Tolal "'''.ro,,' fu.1 U,ed on C:ri~:' O.llon, of Wcnhln,'on Mil.. WClI~ilil~"':UbIIC Wothb"t... lIc.".. fy,l U.ed Toted Public po, Gollo" I. D. N",,,,"r HIghwllp Nu....' IAI III lei 1'1 t'l .. TOTAL Submit report with ren,itwnce to: State of Washington, Department nf Motor Vehicles, Liquid Fuel Tax J}ivision. Olympia. Washington. II tax is not paid on or before the 20th day of the month, add penalty and interest fur delinquency as provided by Revised Code of Washington (RCW) 82.40.080. o Check here if this is a flOal report and enclose IIse fuel tax permit and J. D. Cards. /, br;IIG (/,,1.\' tIII1JlOr;:.r./. "ertb)' ctf/if)' Ihat ,his rtp"" i... '" Ilrt' he.u oj my knowlet!ge true, corrtCI, and nJl""lt'~ ;11 acc(mJamo" wit" clrapur 82.40 UCIY (lnd QPplkuble ,.es:ulathms. B '" ;;; :. Signil1ure Date ..,.,19,..... :!l ~ :; : '."." .' ". .'.: . .'., ,.".,", ,..:.,....<..' '. >. . '.' .' :.' ". . .' ,", .',' ..').". ,..,'. ...... "",.. '." ..:. .. :'~ '.. '. ': '.' .' .. .. '.' ., ..'. '.' ... ...::.. ." '.' SCHEDULE 1 - INSTRUCTIONS 1. List each vehicle for which a Washington J. D. number is required. 2. Compute column 0 (Average Miles Per Gallon) to two decimal places by dividing column B by column A. 3. Compute column E (Taxable GaUons of Fuel) to the nearest gaUon by dividing column C by column D. 4. Space is provided for ten vehicles, if more are operated in Wash. use Schedule 1 (Supplement). Supply is availabel upon request. SCHEDULE 2 - DETAIL OF WASHINGTON FUEL RECEIPTS (Service Stalion Rece;p/s Only) DATE NUMIII --I':;-~~ x/:O (f'( ...-_/l 111\. ..s ~_/ ~ ..-_ ,PM/. ~ Ir...- - I~_ ,A"M =>. ".~:>-I' NAME lOCATION WASH. 1.0. NUMBER GALLONS INTO VEHICLES INVOIce SEWI .:;,...., ) -"'::>> ) /d-. ..:tc... ----p - "" c-, "-1/r; ~-;; TOTAL 07t73 cj. , ' _ SCHEDULE 2 - INSTRUCTIONS 1. Washington purchase Invoices In detail must be listed by each vehicle. 2. The gallons Ii.led for each purchase invoice should be carried to the nenrest whole gnUon, U,e even gaUons-do nol show lenths. . . ,:: ....:: ':> , \:;;':,' ;,:r ":' ";'., ",.i' ,. :', :.. '.;'. :.';':, ':' :', ,. :: ',., , : . ',:' " <, \'.'\ ' :'. '.,. . ,., ";:,: '" , '. ". " . ' " ."',~ UF 975 :.. STATE Of WASHINGTON DEPARTMENT OF MOTOR VEHICLES LIQUID fUEL TAX DIVISION USER'S USE FUEL TAX REPORT For State, Counties, Cities, and Urban Passenger Transportation Systems Name..... Address ...... Permit Number ..Month.. a.~ 6,6 ....,19..... ... STATEMENT OF TAX DUE THE STATE OF WASHINGTON FUEL --i I. 2. 3. 4. Balance on Which Ta.x Is Due (Line I Minus Lines 2 and 3) TAX, PENALTY, AND INTEREST 5. Use Fuel Tax (Line 4 @ 7~O 6. Penalty (10% of Line 5) 7. Interest (~% of Line 5 on the 21st) 8. Total Due for the Month (Lines 5 10 7) 9. Other Debits or Credits (Explain) 10. Remittance Payable to State Treasurer $ $ -tW-- $ SCHEDULE 1 - COMPUTATION OF FUEL USED ON WASHINGTON PUBLIC HIGHWAYS VEHIClE IDENTIFICATION II Tole'll MILES nAVE LED Gal/on. 0' S,.lins Averogo Fue' U..d on Copadty GOIID"' of Tolol Walhington MU.. Wethlnllton ,""bile WoAl."on of au. F",.. Used Public p.r Gall_ I. D. Llc,n,. Hrghwoys Hlghwo)'l N"',"Mr Nu",", IAI 1'1 lei 1'1 1'1 '- If-- A '1:" A I (.. . v~U'/ I c...---u_ I~ TOTAL Submit report with remittance to: Slate of W..hinglon, Department of Motor Vehicles, Liquid Fuel Tax Division. Olympia. Washington. If tax is not paid nn or before the 20lh day of the month, add pennlty and interest for delinquency as provided by Revised Code of Washington (RCW) 82.40,080. o Check here if Ihis is " final report ,md enclose use fuel tax permit and J. D. Cards, /. btillf,! dilly tIluJlOri:ed. "~rt!bJ' certify thm '''''.r r~'1Orl i.r 10 fhi' he.u of my knowledge true, correct, and c'(l/lIpltlt! ;11 Qccortlallce with dIOpter li2.40 ReW and applicable regulalioll.f. ~ ~ ,. ",' Signature DlIte h,19...... ~ .. D~lted at ,,"c. .. . ,.: ,. ". :..... c. :. .;.." "'c. '. ,'. ,c. ........:,' .. ..'. .' "." . ..' c..... ':. c. . . , ..'.,'." "'C.'-c.'. '. " :. '.'.' '.. '. :,.: , '.". .. ::' :,.' ;'./ ,. c. ,: 'c',. " c:, ,,\-, , SCHEDULE 1 - INSTRUCTIONS J. List each vehicle for which a Washington I. D. number is required. 2. Compute column 0 (Average Miles Per Gallon) to two decimal places by dividing column B by column A. 3. Compute column E (Taxable Gallons of Fuel) to the nearest gallon by dividing column C by column D. 4. Space is provided for ten vehicles, if more are operated in Wash. use Schedule I (Supplement). Supply is availabel upon request. SCHEDULE 2 - DETAIL OF WASHINGTON FUEL RECEIPTS (Service Slation Receipts Only) INVOICE SELLER WASH. GALLONS I.D. INTO DATE HUMIn NAME LOCATION NUMBER VEHICLES J_.~~k 112 ""Cy)b l( 3.s-cP "_U'_IC.t:. I.. ~A" ,<1.{ ,t:/,d .2./- , .1_,2-(,{,la 0"/3" .~P.( 'dQ~;J./ - - /,s--zJ ~9'n3 ,.;z. - '~ -~ u e-z> 4<t77J i ,- ; - TOTAL ~(. (J 7- . . . SCHEDULE 2 -INSTRUCTIONS I. Washington purehooe invoices in detail must be listed by each vehicle. 2. The gallons IlSled for each purchase Invoice should be carried 10 the nearest whole gallon. Use even gallons-do not show lenths. . . ", ."'" ',I' ,>, :': ,'C >: :',',"-', ' ,,',' ,,:,:" ',; ',. '.' ,': ' " .' , ,",. ". :' , ..' " . "',', ..' , ,":'" :' '.,' "::' . ,'. " .. , ",." l... I ,.'...,'.C'..'..... ....... . . i<:.' " ,., \ ,..\,:","i','. .. ..'. ,..::, ":: "'.'." " '.'" ...,..',',. '. ,'" . , "" ,.: .. ... ' '. ", ':, ," , , . ", :'" i' . "".' ., : "'. ., ':... ':". .. '..., ',,' .:, "'.':' ." '.' ..".: . -, :- .,.' UF 97B .. . STATE Of WASHINGTON DEPARTMENT OF MOTOR VEHICLES LIQUID FUEL TAX DIVISION USER'S USE FUEL TAX REPORT for State, Counties, Cities, and Urban Passenger Transportation Systems Name.................. ..n' Pormit Number........... Address. .>............. __ co. Month.. co ...,19.......... STATEMENT OF TAX DUE THE STATE OF WASHINGTON FUEL ~ 1. Used on Washington Public Highways (Total Schedule I, Column E) 2. Exempted Use for Highway ConstrucLion and Maintenance 3. ExemPled Use bv an Urban Passenger Transportation Svstem 4. Balance,on Which Tax Is Due (Line I Minus Lines 2 and 3) TAX, PENALTY, AND INTEREST S. Use Fuel Tax (Line 4 @ 9t) 6. Penalty (10% of Line S) 7. Interest (~% of Line 5 ""r Month Beninning on the 21st) 8. Total Due for the Month (Lines 5 to 7) 9. Other Debits or Credits (Explain) 10. Remittance Payable to State Treasurer $ $ 1$ SCHEDULE I-COMPUTATION OF FUEL USED ON WASHINGTON PUBLIC HIGHWAYS VElllCU IDlHIIFICAIIO~' i::~~~)' II Gall:t,:~ af W"t'I&,I- Uon,. of lu, h.1 U,ed N';"";" Numbe, (AI I IF _J ---[ ,- -----""1 r I ~ -----1--.. ~- : ,[ -- I II. ----. ---::t- --,--- -----'-1 ..~~~~~-- Walhlnglon Public. . HJghwa)'1 1'1 '-101 Av,'Clgo Mil.. p" Gallon 1'1 1'1 Gallon. at fu.1 UNd on Wa.'tmlt::.~...bllC 1'1 -- _.,- ~ Submit rcr<lIt with remill(\nce to: State of Washington, Deparlmenl of Motor Vehicles, Liquid Fuel TalC Division. Olympi:l, W:I.hinglon. tr ".. is not paid on or before the 20th day of the month, add penalty and interest for delinquency 'IS provided by Revised Code of Washington (RCW) 82.40.080. o Check here if this is (\ final report and enclose use fuel tax permit and I. D. Cards. I, ht"lflf.: tJlIly amlwri:'t~.J, ht'feby ce"'ify that this report I.f 10 tilt' beH of my k'lOwJedge trllt, correct, and ('omplttt> In a(','ouJm,ce witll clwl'ttr 82.40 ReW and applicabJe regu/m;o,u. ~ '" .. ",. Signature Title.m.._..... ... Date .........,19.......... s :;; Dated at v; .' ,".: 'c." ,'., ... ",' .,1 ::''c'' . ',':;'"> . i ;: .'.'.. ':.:::. , ';, ',:", ',' ,'".'.: ",', ,".'.' :<."'..,.. , , ,':, <",~/ ':"1" i' ',.' ',;, .. :':.: ....,i'.: ,.':... .'. ,','.. ,:.'.::'.:,,', ,,;., ,,:., , '..' ,':'..' ;:.: I.L ,w.Ii . . :'. <...; ,,' ...,t.: , :., . ....' . " . .... '. .' .. . . i.,>.> '.'.< . .... .,,: " . '.: ' .: ,.,::,.. . ...., . ;'::.' ',' .'" : ,,.' '" . :'., ..' .;': " " .';' . ' ..': ,';'. ..,", . ... ,'.'''.' 'f. ,':" '.'. :.",': ,'.<' :., "'-.. : SCHEDULE 1 - INSTRUCTIONS ~ J. List each vehicle for which a Washington J" D. number is required. 2. Compute column D (Average Miles Per Gallon) to two decimal places by dividing column B by column A. 3. Compute column E (Taxable Gallons of Fuel) to the nearest gallnn by dividing column C by column D. 4. Space is provided for ten vehicles, if more are operated in Wash. use Schedule I (Supplement). Supply is availabel upon request. SCHEDULE 2 - DETAIL OF WASHINGTON FUEL RECEIPTS I (Service Station Receipts Only) INVOICE Sl!lLER DATI HUM.1e HAM! LOCATION WASH. I.D. NUMBER OAUONI INTO VEHICLe TOTAL SCHEDULE 2 - INSTRUCTIONS J. Washington purchase involccs in detail must be IIsled by each vehicle. 2. The gallons listed for each purchase invoice .hould be carried to the nearest whole gallon. Use even gallons-do not show tenths. . . :i!~ : :";;"":>:: "'/ "., .. :";;':,,,',",:,:;<::.', ": ,.r , '," '" '" '",".: '.,,'. ','",', ' ,,," ," .:':",:<>.,:,: ,:,,,,'/ ..,', ..:,,',. ,'" :'.'.'", , ,,:, '",:, .,' " . "':"" ',. :":',.:'" '. '. ". " :".:.", ': '.'. " "', ", .., , ',' , ,'..' ,': '." .':'; , ," ':,' ;"""" . .: ," "..', .,~ , . ,.' ..-,:,:'.'- "", ,,', '",: .".' '. ":.,'<<,', '--.. ,." . ", --.' , :-,' ,.':,: ".:.' ,':.<>. "::" ' .,. <': " ' . ..,. '.. :' ' :', ",,' , , :.:: ." ,.,: '" ':,. -: : :', ,', ,,,,;: " -- ,,': :'. ;" ,.,: :, .': ',;, UF 97B . STATE OF WA5fHNGTON DEPARTMENT OF MOTOR VEHICLES LIQUID FUEL TAX DIVISION . USER'S USE FUEL TAX REPORT For State, Counties, Cities, and Urban Passenger Transportation Systems Name...................... ..h...h..................................................... ............... ....... -.. ....... Permit Number..... Address ...............n..........................n................ --'--,.--.__ Month____ ...19..__._____ STATEMENT OF TAX DUE THE STATE OF WASHINGTON FUEL J. Used on Washington Public Highways (Total Schedule I, Column E) 2. Exempted Use for Highway Construction and Maintenance 3. Exemoted Use by an Urbao Passenger Transportation System 4. Balance on Which Tax Is Due (Line I Minus Lines 2 and 3)" _- .... TAX, PENALTY, AND INTEREST 5. Use Fuel Tax (Line 4 @ 9t) 6. Penalty (10% of Line 5) 7. Interest (~% of Line 5 per Month Be.innino on the 21st) 8. Total Due for Ihe Month (Lines 5 to 7) 9. Other Debits or Credits (Explain) 10. Remittance Payable to State Treasurer ~ GALLONS ==t I ~ I $ 1$ SCHEDULE 1 - COMPUTATION OF FUEL USEO ON WASHINGTON PUBLIC HIGHWAYS W..hlnglCNI I. D. N...... ll~.... Nu",", 'I II d~"" TRAV"', ---1 Seatinil Totol ._....___.___ J e""Ur I O.IIM. .f l w..M."M ~"W f.ol U..d '...1 "'", Highways - 1-- (A) _,_~____ _. (el I =-+--.- I ----i -, - l . , I A".ro"o Mil.. pe' Gallon VEHIClE IDfNTlflCATlON ('I Gallona of FUll UNCI ... Wa~;.\,::'~bIlC lEI TOTAL J[_ J[~- 'I -.l'-----~ ~~ ---,-1--==1 ~ Submit report with rcmiuance to: State of Washington, Deparlment of Motor Vehicles, Liquid Fuel Tax Division. Olympia, W,,,hington. If tax is not paid on or before Ihe 20lh d<lY of Ihe munth, add penally and interest for delinquency <IS provided by Revised Code of Washinglon (RCW) 82.40,080. o Check here if this is a tinal report and enclose use fuel lax permit and ), D. Cards. I. ht';;,/: (/,,/)' awllOriu./. "~r~by {,t'rtify ,hat Ihls report i.f to fhl" he.,", of my knOldi!dge true, correct, and c'(lm"/t'If! ii, mxorlJmrct" wi,h cJWl'lU 82.40 RelY and applict,ble regulmiolls. ~ i!i " .. ",' Signature . ..h.....__n.... ..........n....~.. Date --. .m.____, 19........._ ~ :; Title.._.___..... Dated at ...-.-.. H.... h.._. '.. .... B.... "_'h'._ " :,:: : ,'," ::i". : :" ':'.' " i' , . ",::"", 'I:, '.,,'';, ,,; '. '''i ., ,,: '," " '. ,". ,,: " ',,- ": ,'" ,:" .: '. ". .' ':,:": ,,:";' , :.,', '::: :,' :' :" ,: " "':', ,:,',i ''',:, '., ,:':"", ,::' ,. ....." , " , , ,-, L ,,::Jj ..... ....... ">' . .... ,/. ....., . .' ..:. c:,,: ' . .'.' ":. .' , ...... ," ..... .' '. '. ;,' ' '.' :;;", .... ". .... . .<,': ." ....,.< :,'>". '. .. ......; " ." . '. . , . '.,' :~ .... ".:c., .'. ....' " .. . '... . ". . ,. . .- . .'. ,.'..' .,.... :.,:. .,: ., . .'" ',. .<,' "r C.' ..." .'" ;.. " . " >.:' SCHEDULE I - INSTRUCTIONS I. List each vehicle for which a Washington I. D. number is required. 2. Compute column D (Average Miles Per Gallon) to two decimal places by dividing column B by column A. 3. Compute column E (Taxable Gallons of Fuel) to the nearest gallon by dividing column C by column D. 4. Space is provided for ten vehicles, if more are operated in Wash. use Schedule I (Supplement). Supply is availabel upon request. SCHEDULE 2 - DETAIL OF WASHINGTON FUEL RECEIPTS (St!,vlce Slation Realpls Only) INVOICE SELLER WASH. J.D. NUMBER GAl1ClNI INTO. VEHICLIS DATI HUMIII NAME LOCATION ;. TOTAL SCHEDULE 2 -INSTRUCTIONS J, Washington purchase Invoices in detail must be listed by eaeh vehicle. 2. The gallons IIstcd for cach purchase Invoice should be carricd to the nearest whole gallon. Use cven gallons--do not show Itn/hs. . . : .' '''', . ',:, }f: ... '" ,"',: '. ','i",'" ': .. :..../ ""', ":" " ,"'" ',' i,','::',::' ., .',i ~., {c' " . ',.: ,; ", ,'. '.' "', .Y. ,':.. i, ,."'" :""" ,;:':', ,. :." :", :. ". " ':',:,',:,." ",'.,' ','.. ': "",': '!, ", :'"", .,," . . ".r' .,':, : " ,'. .,:.~ .,', .<',... .,'. . . ::,,'-' . ...... . . ..;' .. ..:' " " .,. '. ". . . . ..... . ". ..... ...... . : .... '. ............ .... ..' ":' "'.." . . ." . ..' .... . ..' . ':, :".' :." :- '.: ..':.. ,. '.' ';..' '. .. ',: ...:,': .:'.'. '..., .> : .'. ... '.:' . ..,....; . '" , :;,,;,:,' :: ;::,; .,:, UF9n . . STATE OF WASHINGTON DEPARTMENT OF MOTOR VEHICLES LIQUID FUEL TAX DIVISION USER'S USE FUEL TAX REPORT For State, Counties, Cities, and Urban Passenger Transportation Systems Name...... .n...._........... .................. Permit Number............. Address .".... Month. .__ ..,19__.0.___.. STATEMENT OF TAX DUE THE STATE OF WASHINGTON FUEL 1. Used on Washington Public Highways (Total Schedule I, Column E) 2. Exempted Use for Highway Construction and Maintenance 3. Exemnted Use bv an Urban Passenoer Transoortation SYStem 4. Balance on Which Tax Is Due (Line I Minus Lines 2 and 3) S. 6. 7. 8. 9. 10. TAX, PENALTY, AND INTEREST Use Fuel Tax (Line 4 @ 9t) Penalty (10% of Line 5) Interest (~% or" Line 5 ~r Month Be-innino on the 21st) Total. Due for Ihe Month (Lines 5 to 7) Other Debits or Credits (Explain) $ Remittance Payable to State Treasurer 1$ SCHEDULE 1 - COMPUTATION OF FUEL USED ON WASHINGTON PUBLIC HIGHWAYS lIu..,. HII",t..r II MillS UAVELED Gor,:'~1 .f --"----1- f....1 U...:t Total fAI II) i '1-~ ---::~ -!----j 1-----. I I I t'----- -. 1'1 GalllNlo of 'uol U.MI on WO'Wi'.e..;'bIlC ('1 VEHICLE UlENflflCATlON W~at... I.D. N...... hating C:r:~:' WClthlnglon Pllbllc Highways lei Av'rago Mil.. p" ekln." --- ------1 TOTAL Submit r.port with r.mittance to: Slale of Washington, Deparlm.nt of MOlar Vehicl.s, Liquid Fu.1 Tax Division. Olympia. Washing Ion. If tax is not paid on or bcrore the 20th day or Ihe month, ndd p.nalty and int.rest for d.linqu.ncy as provided by Revis.d Code of Washinglon (RCW) 82.40,080. D. Check h.r. ir this is a Ii mil reporl nnd .nelose use ru.1 lax permit and I. 0, Cards. I. bring ,July IIll1lw";l.t"i/. hereby (en;!)' Ihat this report ;.f to ,he best of my klloIi'Jed.~e trut, correct, and l'ompltl~ ill flt'CeJrt!allcr "',.,,, dropleT 8~.40 RCW and QIJplic:ablc regulmi01u. ~ r;; " ",' Signature Oat.. ..... .__0000....,19'00'.'.'" s :;; Titl...__.....,. Dat.d at .:' '.,.), ':. .\::,:' . ,::", \,," ":,: :' '..,' .,',' '.":" ' i> , ::,' .,.' . .',' . : . :<" " .'.' "':::,:.\' . >", ,',: '.. '" '" '.',," "',""". '.. 0 ",",' '.",,\ .,.'.' ." ':." OLi:, l~ '.'. "'. , :.,.".." ~I , ' . .' . . , .. ..,' , ":',:. , ",,' "',, ' , ',', '," ",.,',' ",,' ", ,,' "', ":,",, "."..:::,: "! :" '<., " ',,: ,'" ",' , :, , ,. , , . ," c.' " ., ' ',:.': ".:,: '.' ':',.' \0, :"::"" :' '. :': ,..'.:,," .:' ,,'" '. '.d'< 1 .,' ;., :,:., }' ,," '" :.. " , ,':' , ;;,;'.',,.t::, " , . , .,C, ',., ",,, ,','- '.';' '" SCHEDULE 1 - INSTRUCTIONS I. List each vehicle (or which a Washington I. D. number is required. 2. Compute column 0 (Average Miles Per Gallon) to two decimal places by dividing column B by column A. 3. Compute c:olumn E (Taxable Gallons of Fuel) to the nearest gallon by dividing column C by column D. 4. Space is provided for ten vehicles, if more are operated in Wash. use Schedule 1 (Supplement). Supply is availabel upon request. SCHEDULE 2 - DETAIL OF WASHINGTON FUEL RECEIPTS i (Suv/ce Station Receipts Only) , INVOICE SELLER WASH. GALLONS , I.D. INTO DATI HUMin N.... LOCATION NUMBER VEHICll'S , i',~ I' t'~ ~: rt, .' ! TOTAL SCHEDULE 2 -INSTRUCTIONS 1. Washington purchase Invoices in detail must be listed by each vehicle. 2. The aaJlons listed (or each purchase Invoice should be carried to the nearest whole gallon. Use even gaUons-do nol show Itnlhs. . . "" " :, ';c, ,: " ", /;, :::" .,,': " ..". ;"'\', """"", ,,:, , ": '~"'!..,: :'"' .'!::: " .', "',: ." ," ':, ",,",'/;':' " ., ,,' ;, "''''', ,"". ': ,/ ': :' '''''', ,,', " :;/. '/:::>,:,:, ":':,':,;';:,'.",' , , . :',' ,,':, ~I ,', ." . !'~ "".'. ::.' ~ ' . J , , ,":.' :' :' , ..;'., ':'."',",":,, " ".,' " ,,';'. :' " ,': . .., ':<.- ".: ," , " '. " :. ',:',' ..',.:: ':, :.,- ,,' ' ,.',., '.::, ,. ,.' , , .. , ,:: ,'>::' :':, ',: .' ,,:':,,",", :".:""" '.,-',:.. :'>':',,:: ". :, ~ llF 97B . STATE OF WASHINGTON DEPARTMENT OF MOTOR VEHICLES LIQUID FUEL TAX DIVISION . Name.... .... USER'S USE FUEL TAX REPORT For State, Counties, Cities, and Urban Passenger Transportation Systems .......................h.................... ... Permit Number. .............................. Address -...............................................~ '. Month .q. ......, 19'h~'''h' STATEMENT OF TAX DUE THE STATE OF WASHINGTON FUEL I. Used on Washington Public Highways (Total Schedule 1, Column E) 2. Exempted Use for Highway Construction and Maintenance 3. Exempted Use bv an UrbaD Passen~er Transoortation System 4. Balance on Which J:!'l' Is Due (Line I Minus Lines 2 and 3) TAX, PENALTY, AND INTEREST GALLONS S. Use Fuel Tax (Line 4 @ 9t) 6. Penally (10% .~~ Line S) 7. Inlerest (~% of Line 5 per Month Beninnin~ on the 21st) Total Due for the Month (Lines S to 7) Other Debits or Credits (Explain) -] $ 8. 9. 10. $ Remittance Payable to State Treasurer 1$ VEHICLE IDlNl'lFICATlON -III /1 ~r MItES TRAVELED c':;~~r, I G.;':~~' ., --1---".";;;;;;;;-- w"t~~- 'kM" ., ... f..' ".... T.,., Hl:h~~" ......., --'::-~--ir-=---t=~: . ._--~~._- - lei --.--. I I If - II i II - -+----=:il--- II----:~-_=:Jr -.-f-----j 'I" --------.-1 '--, ------1--.--- Tor.. I ! SCHEDULE 1 - COMPUTATION OF FUEL USEO ON WASHINGTON PUBLIC HIGHWAYS 1'1 Gallon. of 'u.1 U.ect_ Wa";J;:'\':,:Ubl/C I') Av"og, Mil.. p., Gallon Submit report with remiUance to: State of WlIshinglon, DepJrlment of Motor Vehicles, Liquid Fuel Tax Division. Olympia. W"shinSlon. Jf Inx is not p"id on or before the 20th day of the month, add penalty and Interest for delinquency as provided by Revised Code of Washinglon (ReW) 82.40.080. o Check here if this is a lin,,' report and enclose USe fuel tax permit an~ 1. D. Cards. I. be-ill,&: t/ul,\' tllllllOriud. hl'reby (,~r1;f.l' ,hm tltis rtl'ort i.f 10 t"~ hl!.'fl of my kllowll!dgc Irut!~ correct, and C'omp/~lt in Q('C(mlaftct' 1\.';'" chapler 8J .40 RCW {lnd QPp/iCtlblc I"t!gulafiofl.f. ~ '" .. III' Signature .....-......".. -'.. ................--...... D"le '... ..--.-...-.... ,0.... '..hm.o., 19.0.0.,.." s :; Tltle.m.hh....... D"te~ at ..-. .......-....,H._........._h....".._..........~. ,'C: ,.: " [, ,:,':,'.,,",', ,:,',:"', "',;':'1,' ,,' :.' :,' '..'" '.' :' , .;,.: :', :','" ,,',' ''','. ,,":",',: .:, '.:, ':", , , ' , ',' <<'",,:, ',/ -.' '/ "'., .,,"::" "I '','-'' :',," :'/, """ ,,' ,', ". ':" ':',,:, I', '.'" I .,', ,~,,, , ,,':" , ,i,': :' ::.''' "', ,: ':':',,,:":, . ' .:,:",:..,t':: ":, OL ....,il .:..... " .;: C.,. .,', .' . "".",. '....' '... ", , . '. ';'" ,. . . , " .' ,;' ,.', '. '. ,,',:. '.':. . , " ,,',' '. . .., .',' " ,." ,',.', . . ,"'.' ,'. .',. ,.,' '\, .". ',"., " :. -.', .' . '.',' ", ....,; :':"'" .' .- ' . :... ",::" ,c ,-,.:<. '.,,; '. ::.'. -..: ,'.. ,:,'.... ',', SCHEDULE I -INSTRUCTIONS 1. List each vehicle for which a Washington I. D. number Is required. '2. Compute column D (Average Miles Per Gallon) to two decimal places by dividing column B by column A. 3. Compute c:ciwnn B (Taxable Gallons of Fuel) to the nearest gallon by dividing column C by column D. 4. Space is provided for ten vehicles, if more are operated in Wash. use Schedule I (Supplement). Supply is avallabel upon request. SCHEDULE 2- DETAIL OF WASHINGTON FUEL RECEIPTS (Suvlce Slalion Receipts Only) INVOICE SELLER DATI! HUMin NAM' LOC4TlON WASH. I.D. NUMBER GALLOlG INfO VEHIClIS TOTAL SCHEDULE 2 - INSTRUCTIONS J. Washington purchase Invoices In detail must be lisled by each vehicle. 2. The gallonllilled for e.eh purch.... Invoice should be carried In Ihe nearest whole gallon. Use even gallons-do nor show ttnths. . . ~~ '.,",,' :..',1:, ': "."," .,,,:, ':':.',';:'. ,,' ,-'.,',:' " '" ",:i. :" "'; ""." ''', '< ":::',:'..:",' ".,:, "",,' '" ",'" , "; :. ,",::'" ,,' ',I '. ,," :,"" ", ' ',,: .,.:: ',' . ' . :", " ". [,', ; '''~ '.'.' .', . .: '.: . :.. .. ',.. :.,,: '.":,: ',.' :. ".. ...... ... ,> .... .' .:" ..... .,... ",., '. :.-: .,,,, '.::', . .'. .... ".'. -: :'. ' .., -,':..:~, "..' ,.' ,. ..',:' +< , UF 97B . . STATE Of WASHINGTON DEPARTMENT OF MOTOR VEHICLES LIQUID FUEL TAX DIVISION USER'S USE FUEL TAX REPORT For State, Counties, Cities, and Urban Passenger Transportation Systems Name.............. . . Permit Number............ Address.. __... Month... ____..,19...__...__ STATEMENT OF TAX DUE THE STATE OF WASHINGTON FUEL GALLONS 1. Used on Washington Public Highways (Total Schedule I, Column E) 2. Exempted Use for Highway Construction and Maintenance 3. Exemoted Use bv an Urban Passenger TransDortation Svstem 4. Balance on _ Which ,!'al' Is Due (Line I Minus Lines 2 and 3) TAX, PENALTY, AND INTEREST S. Use Fuel Tax (Line 4 @ 9i) 6. Penalty (10% of Line 5) 7. Inle,est (lh % of Line 5 ocr Month Be"inning on the 21st) 8. Total Due for the Month (Lines 5 to 7) 9. Other Debits or Credits (Explain) 10. Rcmhtance Payable to State Treasurer -l__ I $ l $ I $ SCHEDULE 1 _ COMPUTATION OF FUEL USED ON WASHINGTON PUBLIC HIGHWAYS VfHICU IDENflfICAr~OH Mollng II TOlol m._.___~~-~~-l C:ri~:" Gallo", .f J WCllhl"liiI'." w:"'::.I',. ~~::'::f fu.1 U..d hlol HI~h':~'" _-= ~-_. : -f=-~ --- III --=~~-- lei =--- -- -----~e------i . ---- I I --, --- I ! =-__ --==~ ___~~~--~jF------f--- -.--- -..---.---jr--.-J -------11------- i I: AV'rallo MlI.. p" Golfon Gallon. 0' Fuol U.ed on Walh~i.e~bIlC 1'1 1'1 TOTAL Submit report with remillance to: State of Wnshington, Department of Motor Vehicles, Liquid Fuel Tax Division, Olympia. Washington. If tnx is not pnid on or before the 20th day of the month, ndd penalty and interest for delinqueney 'IS provided by Revised Code of Washinglon (RCW) 82.40,080. o Chec~ here if this is a tinal report nnd enclose use fuel {:IX permit nnd 1. D. Cards. f, bring dilly mllllOrht"d, h,.,."by ct"rti/)' ,lIat this rtrOrl i.f to lire heH 01 my knowledge trut, CDrrect, and (,()trIpii'll: if, (lc.'COTlJ,l11Ct" ",illl c/rapter 82.40 heW and Ql'plictJble reglJlmimu. ~ '" .. ",' s :;; Signature D,ltc p__ ....______.,19.......... Title......... Dated at ." : ." ,: ':'::':';'" '., '. ',' ." .' . .':-\: ""'":''''' '.,.../. ,,'... ' ";';"""":"',.' .. ". :-:'.... ,..,.':::,'-". ',: ", '" : ',.' . ,:', . "., :.' ", <, . .......' : ';;.,,:. , . ..... c',,'; .' .'.'. ..... '. ;," '.,', <;:,< '.. ";':' . . ,.. . .'.. '. . ;..... ..' '.',. !~ 'i ~'.' >....... .. ...... .'.. .'" .' '.'."... '.. . . . " . ...". '.,: . .... ......... ..... . ........... .. '...' >>." '... ....... ,... ,,"': ... ... <....'.. .... .' ., . . .,..'.:' . .. ., '.. i; .,.>' .'. . ,,' '. .', ,.... :. '. .. ." >< '. . '::.,:. '.':' <. . ,.):'\'.,: .:, ' '. . , ... .' . :' : ..' '. . ,<' >.' ',.:. SCHEDULE I -INSTRUCTIONS 1. List each vehicle for which a Washington I. D. number is required. 2. Compute column D (Average Miles Per Gallon) to two decimal places by dividing column B by column A. 3. Compute caIumn E (Taxable Gallons of Fuel) to the nearest gallon by dividing column C by column D. 4. Space is provided for ten vehicles, if more are operated in Wash. use Schedule 1 (Supplement). Supply is availabel upon request. SCHEDULE 2 - DETAIL OF WASHINGTON FUEL RECEIPTS (Servfce Station Receipts Only) INVOICE SELL!R WASH. I.D. NUMBER DATI! HUMin H.... LOCATION TOTAl. GAlLONI INTO VEHICdI SCHEDULE 2 -INSTRUCTIONS 1. Washington purchase Invoices In detail must be listed by each vehicle, 2. The aallons listed for each purchase Invoice should be carried to the nearest whole gallon. Use even gallons--do nor show ren/hr. . . ". . :,.i,., ". :.:'''. "", ;'." ,":: .,' ." . ..> ','. .. :.. >:. ", ". '. ",:.:,>,,',;,' .' .' , ' ..' "", :. '" ", . " ...... ," ',' .'. I, ,,' "" .', ,..':_<::'" . . '.' :':'.: :.....:;. ;,: ,;' ."',:: :", .' ;,'. "i "'---. ".' . ';"'." '. .... :....1 ~; ',. ., ,', ,.' ;,' , 'I,' .', .." ',' ,': ,.,,',. ,"" "" i '"";,, ,,',';' ., "'< ,," '; " , , " .. "',;, ,', ',:' , ,,'" " " ,," ,', :""<'<: , ,'. .",'. .;". , , ' "/.,,;',: ,",' ,'. ',,: ,/, "-: :;: UF 97B . . STATE OF WASHINGTON DEPARTMENT OF MOTOR VEHICLES LIQUID fUEL fAX DIVISION USER'S USE FUEL TAX REPORT For State, Counties, Cities, and Urban Passenger Transportation Systems Name.............. ............__......._. Permit Number............ Address.. ........... Month...... .,19___.__.... STATEMENT OF TAX DUE THE STATE OF WASHINGTON Remittance Payable to State Treasurer ~ 1$ , I $ I $ FUEL 1. Used on Washington Public Highways (Total Schedule I, Column E) 2. Exempted Use for Highway. Construction. and Maintenance 3. Exemoted Use bv an Urban Passenoer Transnortation Svstem 4. Balance_.on Which Ta.x Is Due (Line I Minus Lines 2 and 3) TAX, PENALTY, AND INTEREST S. 6. 7. 8. 9. 10. Use Fuel Tax (Line 4 @ 9') Penalty (10% of Line 5) Interest (~% of Line 5 ocr Month Beoinnino on the 21 st) Total Due for the Month (Lines 5 to 7) Other Debits or Credits (Explain) SCHEDULE 1 - COMPUTATION OF FUEL USED ON WASHINGTON PUBLIC HIGHWAYS J I _____. I I --- ---l-- . ----1 f-- ~ --I --- 1--------' -- 1---- -~===== -~ i ~r --:-.- ------.,--...~ -'--l-.-.---i'.,------ -' Ii I W_lotll'- I. D. N.....' UCIIIIII ......., Seollng Capcocl1r of 1\11 JI Tolal Gall..... af fll.1 U.... IAI I. MILES TlAVEUD '-.--'-'-L W-;.h';;;;;- Tolal PloIbUc HI;hwo)'t III . rei ------ --t- A....rag. Mil.. par Golla" VEHICL& IDlNTlflCAllON 1'1 Gallon, .f Fuol UI" 111ft WothJ:'eSJ::~lIbllC 1'1 JOJAL I Subnlit rCIX"lrt with rcmittunce 10: State of Washington. Dep:lr1menl of Motor Vehicles, Liquid Fuel Tax Division, Olympi... W..,hington. If tax is not p..id on or before the 20th d..y of the month, "dd penalty and Imerest for delin'luency as provided hy Revised Code of Washing Ion (RCW) 82.40.080. o Check here if this is a final report and enclose u'e fuel t..x permit and I. 0, Cards. T, "t'inK duly dwlwriud. IIt'rthy c~Ttil.\' that this Tt'po,t i.v Ie) tire bCJI ()f my knowledge tru~, correct, and complt'lc ;11 Qccor,/mrct witll clraJ,ur 82.40 RCW and Ql'l'liclIhtt I'tgll{atiOlU. B is '" :. Signature D..te, .., ...........,19.......... ~ .. TiUe...._n......, O..ted at ,I' :[:,' : ":': ;," "j '",' "," , ....,. .ii,'. .'" ",'.' '.'" ' ", ,: :'~. '.":,." " . ." ":,',':,", ,'" ' , ,'.';:, :. ,: ,,,,:.,', " ,,>.,.,', . "',:',' ." "i'", ". ,;':':'; ,,' ,"" ".... '. .,......... '. . '.', .', '. ", :.' .. "., '.,,' ',: . , ,,',.. '.,' . '. "..,':', ,...., "".'. ...', ,..... '. . "",.' .",'.. .,', .:.' .",. ,:.: " .:'. '-', . :: .':':: " "':''.;.. ".',. , '/:, .. ':, '':' I " ".. '. . , ' ':' :, :: SCHEDULE 1 - INSTRUCTIONS 1. List each vehicle for which a Washington I. D. number is required. 2. Compute column 0 (Average Miles Per Gallon) to two decimal places by dividing column B by column A. 3. Compute column E (Taxable Gallons of Fuel) to the nearest gallon by dividing column C by column D. 4. Space is provided for ten vehicles, if more are operated in Wash. use Schedule I (Supplement). Supply is availabel upon request. SCHEDULE 2 - DETAIL OF WASHINGTON FUEL RECEIPTS i (Service Slation Receipts Only) , INVOICE SELLER WASH. GAlE.OIII I.D, INTO DATE HUMIE_ NAM. LOCATION NUMBER VEHle.. , , , i i I I I " TOTAL SCHEDULE 2 - INSTRUCTIONS I. Washington purcha... Invoices In detail mu.t be listed by each vehicle. ; 2. The gallons listed lor each purchase Invoice should be carried to the nearest whole gallon. Use even gallons--do not show ttnths. I . . " :'.: " :" ":; ';:; ,. ci ":'/' ',' ... <": ',,' , ,':", .,' ", ";::', ':",:, " " ',.: ',:" '.. .-' ',", .: " ',',,: '.;. " ' , .'" ':': :' , .- , , ' ',' " .,'.' "', ""'",:,,. . \:.' "",;:'.' .' :,,: "I>,;:' .:' ..: "::, ":, ", , ',' '. "",., "','..',',' :, , ,',. ".::,' ,,/ ':\.:' ':,'., "" ..,.-,," ",' " ':,"',,' , ": ." ,." IiIt:..c. I ..J L. ,. ,: .,:. ., , ' , , . ',' ,:. " :.,,:,. ,': ,'.: ',';, .:." ,.. ..,:.,' . '. . " '., ' ,. ,,:,' .,. " " .;. " " , .,," ",', ' 'p '.':'.' ,/ ",",, " ,,' """ """ ,. ' ,'.'. ,', :.' '" " ,,'::. "". : .c: :, SCHEDULE 1 - INSTRUCTIONS 1. List cach vchicle for which a Washington 1. D. number is required. 2. Compute column D (Average Miles Pcr Gallon) to two decimal places by dividing column B by column A. 3. Compute column E (TlU:able Gallons of Fuel) to the nearest gallon by dividing column C by column D. 4. Space is provided for ten vehicles, if mnre are operated in Wash, use Schedule I (Supplement). Supply is availabel upon request. SCHEDULE 2 - DETAIL OF WASHINGTON FUEL RECEIPTS (Service Slatton Receipts Only) INYDla SELLER DATE HUMin H.... LOCATION WASH. I.D. NUMBER GAUota INTO VEHICIIS :cc- . -.. TOTAL SCHEDULE 2 - INSTRUCTIONS 1. Washinslon purchase invoice. in detail must be listed by each vehicle. 2. The gallons listed (or each purchase Invoice .hould be carried to the nearest whole gallon. Use cven gallons--do not show tenths. . . ",:', :" . "",: ':"; ';,'," ":', , : ::':: ',,":' ,', "" /',:,,":.'.,,:,; "<',,:'" " ",f' ':, ",:~',:'(:: "" '.', ,"t "':..:"" ::<, ',i, '.'; .. ,:' ',: "',',\ . ,~ :'." ,.:, ",', " ",:" " ," ',' ':, '. :,: ,"". ,"": ' "'. .", ,. ", ":>:' :: .",' ',: : '" ":,.. , ,,'.: ,',', " :' .: ';. ,'",. .", '.., '.' ., ' " " .',' .' '. :', ,. ,,',.. "",,:,' '::' , :, , .,"', ::; ,'" ,< '. ::" " UF 978 . . STATE OF WASHINGTON DEPARTMENT OF MOTOR VEHICLES LIQUID FUEL TAX DIVISION USER'S USE FUEL TAX REPORT For State, Counties, Cities, and Urban Passenger Transportation Systems Name...................................................................n............ .... 'un. Permit Number.............. Address_..... .__. Month. .h, ...",19._________ STATEMENT OF TAX DUE THE STATE OF WASHINGTON FUEL .~ -1 I $ I GALLONS J. Used on Washinglon Public Highwa;ys (Total Schedule I, Column E) 2. Exempted Use for Highway Construction and Maintenance 3. Exempted Use by an Urban Passenger Transportation System 4. Balance on Which Tax Is Due (Line I Minus Lines 2 and 3) 5. 6. 7. 8. 9. 10. TAX, PENALTY, AND INTEREST Use Fuel Tax (Line 4 @ ge I Penalty (10% of Line 5) Interest (~% of Line 5 [)C.r Month Beoinning on the 21st) Tolal Due for the Month (Lines 5 to 7) Other Debits or Credits (Explain) Remittance Payable 10 State Treasurer $ I $ SCHEDULE 1 - COMPUTATION OF FUEL USED ON WASHINGTON PUBLIC HIGHWAYS rl T.,., ~....._~.~T~-"~D_.__ I G,.",..v'...' r I I w""hrn,"~ IN . 010 1 PI/bl, HI"hwoY' F' fA) __ ____._~~._ - __'_'_ fe) .----1- i---.---- I ---"--, I -------i-~ I , -- --- !---i----lf ---- -- f-- i -.Jr=__ -.------,------ ~----I ---11'.------ TO'AL I VIHICU IDENIlPlCATlON Wolhltlgt_ I.D. -. Un".. NwrnlNr SeolinG C:ri~:Y Av.,a.. Mil,. p" GoII.., 1'1 GollCMI' ., Fu.' U......, WDIh~r.f::';'bIlC (" Submit rel,ort with remill:lIlce to: Slale or Washlnglon, Department of Motor Vehicles, Liquid Fuel Tax Division, Olympia. W..hinstoll, H lax i. not pllld on or before the 20111 dilY of the month, add penalty and Interest ror delinquency 'IS provided by Revised Code of Washington (RCW) 82.40.080. o Check here ir Ihis is a final reporl and enclose U.e fuel lilX permit and I. D. Cards. /. ht'iflg (Jill)' "UI"o'-;:'~'t/. "t'r~b.\' c~,'if)' ,lrat ,hi,f '~P(}rl i:f to f"~ bt!M oj my knowlt'dge t,ue, corrtct, and flllllpltfr ill ('cCor"(lIK~ ",ith c},apfrr 8~.40 RCW and Gl,pllcabJe I'tGulalirm.s. ~ ;;; :. Signature Dale ,. __..........19__...,.... ~ ~ .. TiLle.._._..___ .. Dilled aI, :; ';:,' i'':.< ',", '", I ',', i, ''', i<', I ''. ,,: ,::" :>':; ':' ,~ 1 ':" " '" "i', . .'d,''' ' ,:' "',..,: :'> " I . " ", ':' :'-"" ',' ;, I ',.', ". . ..... .......... .... ..' . ." ......:' . ....... . .'. . ". .. . .' ...;. .' .... .- ..' '" . .. ... ........ '.. .':..' . . " :>" . .'. ." : '.'. .' "'. ". . '. ,: ,,' i.. . ',' :. ., ..... .' .. "'. :{ ~ ':: , '). SCHEDULE 1 - INSTRUCTIONS 1. List each vehicle for which a Washington I. D. number is required. 2. Compute column 0 (Average Miles Per Gallon) to two decimal places by dividing column B by column A. 3. Compute cclumn E (Taxable Gallons of Fuel) to the nearest gallon by dividing column C by column D. 4. Space is provided for ten vehicles, if more are operated in Wash. use Schedule I (Supplement). Supply is availabel upon request. SCHEDULE 2 - DETAIL OF WASHINGTON FUEL RECEIPTS (Service Station Receipts Only) INVOICE SELLER WASH. I.D. NUMBER GAlLONS INfO VEHICLIS DATI HUM.EI NAM' LOCATION . . . TOTAL SCHEDULE 2 - INSTRUCTIONS I. Washington purchase invoices in detail must be listed by each vehicle. 2. The gallnns listed for each purchase invoice .houJd be carried to the nearest whole gallon. Use even gallons-do not show Itnths. . . ~.. I:rj.:,{t:!;:\:} '.", ':;,; '.' :' ;.: ",i ","', .' -.,:,.' i'., '.: :',,'" :",' .:,' . ", : '.' I' .',.";:"'. '''. '.' :'''''. ,:": '. "'., :,' 'ii: ".:':1.,:""."" ..', .'.' ........,. '<:'., i '., :;',. ...' '. '. :",'.,.. ": '" ',,: . ,. " i..,','. '.. '-" " ," . < ; .... '.' . ';. : '.' ".. :" ',' ..... .:...... ...... ....... "'.:.. ... .... ..".,,". .'.; . ..::', ;'. .';.., .. >): ..... .' ,'<: ,;,. . .....;:.: :, .. "'..; .'. .:,'.' ....:. .;. '".' ':':".: '::'. '. :.:':. 'J;, :. : -". . .~. ".." . .: '.",: ..; . . UF 97B . STATE OF WASHINGTON DEPARTMENT OF MOTOR VEHICLES LIQUID FUEL TAX DIVISION . USER'S USE FUEL TAX REPORT For State, Countios, Cities, and Urban Passenger Transportation Systems Name............. ......................h............................................................... .... .......... Permit Number....... .. Address........... ......................................................- ........ ...__ Monlh...... ..........................,19.......... STATEMENT OF TAX DUE THE STATE OF WASHINGTON FUEL ~ GALLONS I. Used on Washington Public Highways (Total Schedule I, Column E) 2. Exempted Use for Highway Construction and Maintenance 3. Exempted Use by an Urban Passen2er Transportation System 4. Balance on Which Tax Is Due (Line I Minus Lines 2 and 3) TAX, PENALTY, AND INTEREST ---1 I $ I S. Use Fuel Tax (Line 4 @ 9~) 6. Penalty (10% of Line 5) 7. Interest (v.. % of Line.5 per Month Beainning on the 21st) Total Due for the Month (Lines 5 to 7) Other Debits or Credits (Explain) 8. 9. 10. $ Remittance Payable to State Treasurer 1$ SCHEDULE 1 - COMPUTATION OF FUEL USED ON WASHINGTON PUBLIC HIGHWAYS VfHlCl( .IDEHl'lflCAlION -1 WoMl_.t.. lie...... N~' N......., Slating C:ri~" II l MILES TRAVILE' Total __ Gallon. a. 1 Wlllhllllill~ flHl Uled Tolal '"blic Hl(lhwlI)'J IAI 'II fe) '~-- -=-- -- -r I Av.rag. Mil.. p.r Gallon 1'1 Gallon. of 'u., UHd Oft Wal~::.'C:r:ubIlC I') .1---., ~ ---.- -----11---,.- I , -1 I I --r- ll=- TOTAL Submit report W;lh rernillance to: State of Washington, Department of Motor Vehicles, Liquid Fuel Tax Division. Olympia. Washington. If tax is not paid on or before the 20th day of the month, add penalty and interest for delinquency.. provided by Revised Code of Washing Ion (RCW) 82.40,080. o Check here if thi, is a lin,,1 report and enclose use fuel tax permit and J. D. Cards. I. hfirrg duly (JwhmiUi.I. Irl"reb.\' efrti!)' tlUlI this Uport l,f 10 the heM oj my knowledge trlle, correct, and c()m"/~tt' ill (J(.'('''r4Iarrc~ \,,;,11 C'lzapur 8J.40 RCW and applicable tegllfatloll.~'. ~ i;j " ",' Signature . Title....___,.. Dale. d. __ --.....,...,19_'''_.00'_ s :; Oated at ," ~: i'"" . , .' ~ ' ." ". , " ~'::' ::'! ,". ,';', ii, ' . ':,'.:'. ;c ( ',.' ':...., ,', 'j,.,.":> :.:. ..:\,,:,,', ",", "'" ' ,'i, ..<::,' ",.,.,....' 'i "'::"i>'~', " .'. '.' '.,', '. .',"";' c'.,.", .......-'.- ::.tIll ., .... .'. ...... ...... ...... . .' .., .'. .. ..' ..' .... ". .'..'. ',. '. ' .' '. '-" :;. ','." .' .... : .......', < >:-:. . :' ..... .'.. ."..> ..: . . .; ',: ,.,.:.. c '.:. ...':'... '.. ,. '. ...... .'; ....: ..' .. '.:. . .".: ". .. .- . '. . '.' p . . .". . . .' '-','.' . c. .. . . '.. . ....". . ..' <............... ','.. " :. '.:" ..'. :: , .' SCHEDULE 1 -INSTRUCTIONS I. List each vehicle for which a Washington I. D. number is required. 2. Compute column D (Average Miles Per Gallon) to two decimal places by dividing column B by column A. J. Compule cdwnn E (Tnxable Gallons of Fuel) to the nearest gallon by dividing column C by column D. 4. Space is provided for ten vehicles, if more are operated in Wash. use Schedule 1 (Supplement). Sopply is availabel upon request. SCHEDULE 2 - DETAIL OF WASHINGTON FUEL RECEIPTS (S~,vice Stalion Receipts Only) DATI HUMI.I NAM' LOCATION WASH. I.D. NUMBER GALLONS INTO VEHICI.B INVOICE SELLER : TOTAL SCHEDULE 2 - INSTRUCTIONS I, Washington purchase Invoices In detail must be listed by each vehicle. 2. 111C gallons listed lor each purchase invoice should be carried to the neare!! whole gallon. Use even gallons--do tloI show '~tllhs. . . .:.,. ,': , .'. 'i. ,:'::.,,' ',',Y .,' ". ,'. " . : "', . ,. '. \'. '.:"','. '''' ',' :Ii ", . .:.'" ".' .,':. . " ',', '.:' :.,' ". :. .pi' : ,:. .'.:':. :. .- '., ..' '., ',.'.,' '" c, :' ':" .... . ." " ........' ,:. :....: .....,: ".. " ".. ..: ",:; ,':, ..... ,,".,:.,.,' '.' ,.,', . ....' 'p":'.' '.' 'i', ": ":' ..', .' Iw....... .> .: ": :'('.. .:' . .', :: . .'. ...'., .:" .' .... " .' ..,'. "".; .': ;':,' .... .':' ,.> .'. UF 97B . STATE Of WASHINGTON DEPARTMENT OF MOTOR VEHICLES L10UID FUEL TAX DIVISION ',.' .' , ""./ '. '. ..:' :...' '.:.,. C.. ..'. ..', ,:;' '. .,': ":. ';".., ,..,' . USER'S USE FUEL TAX REPORT For State, Counties, Cities, and Urban Passengor Transportation Systems Name............... Address .... Month .... STATEMENT OF TAX DUE THE STATE OF WASHINGTON FUEL I. Used on Washington Public Highways (Total Schedule I, Column E) 2. Exempted Use for Highway Construction and Maintenance 3. ExemDted Use bv an Urban Passen~er Transnortation System 4. ~aJance on Which Tax Is Due (Line I Minus Lines 2 and 3) TAX, PENALTY, AND INTEREST 5. Use Fuel Tax (Line 4 @ 9t) 6. Penalty (10% of Line 5) 7. Interest (~% of Line 5 ocr Month Beninnin~ on the 21st) 8. Total Due for the Month (Lines 5 to 7) 9. Other Debits or Credits (Explain) 10. Remittance Payable to State Treasurer . .... Permit Number.......... ... " 19.......... I GALLONS I ---l $ $ I $ VEHICLE IDlNJlFICArtON SCHEDULE 1 - COMPUTATION OF FUEL USED ON WASHINGTON PUBLIC HIGHWAYS II "Dol". 'I '''D' d - --~~:'!-~~'''-- COpcll(lIy I GaItO"1 0' 1 WOlhl"lIlon lIn..... ~,.u. fII.1 UI.d ToI,,1 Hl:h~~,. N",",", (AI 'I' (C. ----I -, ---- --=- I ----.J ______--.J -=i-. I -f--.-- I I --1---11 I _._.11_____ -. WOIhI"II'" I. D. ......, ---------, --------j TOTAL ""vorag. Mil.. p.r Gallon Gallon. 0' Fuel Uled 011 WcuhlnlllOl'l'ubllc HIghwlI'" ('1 1'1 ~ Submit <<po,t with remiuunce to: Slate of Washinglon, [)eparlmenl of Motor Vehicles, Liquid Fuel Tax Division. OIYl1lpi;\, W;\shin!1lOn. If tux is not puid on or before the 20lh day of the month, ndd penalty and interest for delinquency as provided by Revised Code of Washlnglon (RCW) 82.40,080, o Check here if this is n tinal report and enclose use fuel t;\X permit and I. D. C...ds. /. /r,.i"F: ~/,,'y 1II1thori:'<<'tl. "~uhy ('~rtifY Ihat Ihl.r rtport ;,r 10 tht' beM oj my Imow/edge true, corr~c', and romp/elt! ;" at'cart/mrce' wilh clUlpttr 82.40 RelY ami applicable regulm;OIu. Signature Dale Title.. Dated at . '.~', ',..:, ; ",,,'. :'"",.,' ',,'."" ,<,.,"" ,':: :",'J. ,/.<' .', ,.,\'.. :".. .' '. "..... .... ';"i: ..... ':. '.::'; ,< :::: .,', ~.. "'- ..:......,'. :: . . ~ ;;; :;:. .19...___.... ~ .. .' : ......:; ,i< " .. '.'" .",.' .(., . 1m '"1 ''-..' .' '::' , ' ' -: ,., . " ' " , :< . >, ,', '" ", ,::,,"," ,::: '",': ,', ';: .:' ': " ' .;.":" "". ' , ' , ..... '.', ~ " :' , ..' :' "., ... :', ': , . ',.., ..' ",' .' ..... , '.' , '. ,,' SCHEDULE 1 - INSTRUCTIONS 1. List each vehicle for which a Washington I. D. number is required. 2. Compute column D (Average Miles Per Gallon) to two decimal places by dividing column B by column A. 3. Compute column E (Taxable Gallons of Fuel) to the nearest gallon by dividing column C by column D. 4. Space is provided for ten vehicles, if more are operated in Wash. use Schedule I (Supplement). Supply is availabel upon request. SCHEDULE 2 - DETAIL OF WASHINGTON FUEL RECEIPTS (S~,.~ice Station Receipts Only) INVOICE SELLER WASH. I.D. NUMBER OAUOfe INTO VEHICLIS DATE NUMaEI NAM' LCCArlON TOTAL SCHEDULE 2 -INSTRUCTIONS I. Washington purchase Invoices In detail must be listed by each vehicle. Z. The 8allonslisled for eaeh purchase Invoice should be carried to the nenrest whole gallon. Use even gallons--do nol show 1~n1hs. . . ~ ;,;,~":,:;::::,~,;, '."', ':"" '>--::' ',",..'" ", '-".:, . ';::, : "',:.. .,:''- ,,', '" ",,"', ,: ., ,..: ,', ,',' ',.; ; :,": ;', .':' .' ", "., ;.' ,'>:, ,,';' :'" '; ',,< .'. ," '" "," ,', :"; .. ,.:.... ',' ::.:. ,',' .'.....,.,':,:,....'" :! "".' :(i, L . ',. ,,: ."". .:" .'. ;,. . '..>iII ........... ...... ..... ,::::, ...... ...... ':'" .' .'. .. '.,:.:,' .. . : '.i: '. <~.:',..:...' "', ....' :...::. .... '..., .. ,;.:....... .':" ;'.' : .... ;'. . . . ,':.. . '."" .'., ,.. . ..' .'." ..... '.:: ,,'.: '.: , :i;/}(i~~ ~ UF 97B . . STATE OF WASHINGTON DEPARTMENT OF MOTOR VEHICLES LIQUID FUEL TAX DIVISION USER'S USE FUEL TAX REPORT For State, Counties, Cities, and Urban Passenger Transportation System5 Name............. u Permit Number........ Address.. .H..qq.. . . .00. __mq Month .0000 STATEMENT OF TAX DUE THE STATE OF WASHINGTON FUEL I. Used on Washington Public Highways (Total Schedule I, Column E) 2. Exempted Use for Highway ConstrucLion and Maintenance 3. Exemoled Use bv an Urb-;'n Passen.er Transoortation Svstem 4. Balance on Which Tax Is Due (Line I Minus Lines 2 and 3) TAX, PENALTY, AND INTEREST S. 6. 7. 8. 9. 10. Use Fuel Tax (Line 4 @ 9t) Penalty (10% of Line 5) Inlerest (~% of Line 5 ocr Month Be~innin. on the 2Ist~---- Total Due for the Month (Lines 5 to 7) Olher Debits or Credits (Explain) Remittance Payable to State Treasurer SCHEDULE 1 - COMPUTATION OF FUEL USED ON WASHINGTON PUBLIC HIGHWAYS j c':::~~I, 1'1 o.r.::::I~f ~I - .\ILEI_JT"V"~~;,;;;;;;;-- of IlIt f".1 UI" TOlal Public HI"hways IAI 'I' fel ---==--, : I ------=F=- --'---'-~--~--r- -.-~~- ____~- ~F~__~ -. ------ --. - --- ,...J --~, ------ -1,1---. --- TOTAL I YEHICLI IDENJlFlCATlON Avora,_ Mil.. per Gallo" W.hln".. r. D. H......, Ueo".. H......, Submit report with remitt.nee tn: State or Washington. Department of Motor Vehicles, Liquid Fuel Tax Division. Olymph.. W'lShinglon. Ir tu, is not pllid on or before the 20lh duy or the month, add penalty and interest ror delinquency I1S p.-ovided by Revised Code or Wnshinglon (RCW) 82,40.080, o Cheek hcre if this is " final report and enclose use fuel lux permit and J. D. Cards. I. bt"in/f dul)' 11I11IIOr;:('4/, ht'rtby ("ertiJy that this UI,or/ i.f to ("~ ht!.H oj my k'lOwlcdg~ 'rut, corr~ct, and "(Jmp/t/~ ;11 accordance wi,h dWI'ler 82.40 RCW and applicable ugu!a1ions. Sisnuture Dale ...........19...___.... TWe..._.._.__.. . Dated at. '.. j , ;' ., ' ,', '., '.:, .i'.:: .'.' ",:.: ,"', .<.,',< .,.- .' " .., .'.: ':,' :",:' ,.'.,'.':., " .'...., ." .,-.' .':. ""'... .... :.,: .' ..: ". . ""':". .. ,:', ','., . '., .", ',,',:' "," ... .'" i '. '. 0..1-...1, 1'1 '< '" . . .....: " . . . .,... .... ,:, ',' ::. : ',,:. . .,. ~: i ..__ .,19..00...__. GALLONS -i I $ I $ I $ Gall_I of '11_1 Uud on Woald".,. Public HllhwD}'l ('1 ~ 1 ~ '" " ",. ~ I .. '", , ': ... \:~ . .; :.; . . ",...' . .; "".'".' .. ',',' . ,,;:. ......, ',' ........,.. , .,'..... .'.,'.'>" ..". ,";<' " ,..' ..' ....: . ". . .',. ,.. ,'.. :",.. ,'" '..' .' . :." :' :'.'" ., ',.' ,-.,: .i,'t~':..:.: C,.... ',. "., . '.' . ~,: . .' . . ..> :;.: SCHEDULE 1 - INSTRUCTIONS I. List each vehicle for which a Washington I. D. number is required. 2. Compute column 0 (Average MUes Per Gallon) to two decimal places by dividing column B by column A. 3. Compute coIW11ll E (Taxable Gallons of Fuel) to [he nearest gallon by dividing column C by column D. 4. Space is provided for ten vehicles, if more are operated in Wash. use Schedule 1 (Supplement). Supply is avaUabel upon request. SCHEDULE 2 - DETAIL OF WASHINGTON FUEL RECEIPTS (Se,~/ce Slalion Receipts Only) INVOICE SELLER DATI HUMaEl NAM' LOCATION WASH. I.D. NUMBER OAUOtII INfO VEHICIIS TOTAL SCHEDULE 2 - INSTRUCTIONS I. Washington purchase Invoices in detail must be listed by each vehicle. 2. The gallons listed for each purchase Invoice should be carried to the nearest whole gallon. Use even gallons-do not show tenths. . . .":',:,,::;, .~ :..' :,',':'. ';,'; ',' ',':.' ."." ,:,' " ,. ,.',/",:, "" ':"':" ",."': ":'.:",,\.,.. "'" ,:,,,,1 ,,.:.:,': :,',' ,,',..,.' .,',',e.". "'.:,-: ., ',.;'..' .:,"-'.,",' '. ' >\., .,. ".". ',:i':,' ,.: .~ ........'. . ". . '. .':'..',.':. . ':'<, '> ." . ,. .............,........ . ... -' .'. .... ".<:'. ..: '." :..: ' :.'..' '..:. ". " ,'. ". ." . ,,,: :- '. "',.'. .; '.. . '.< ,', : '.' , : ..., .. ....; '. '::';:)'. .'.'" ..','. '. >..:.: . ',".. . ::. , UF 97B . . STATE OF WASHINGTON DEPARTMENT OF MOTOR VEHICLES LIQUID FUEL TAX DIVISION USER'S USE FUEL TAX REPORT For State, Counties, Cities, and Urban Passenger Transportation Systems Name...n...................... .. .... ..................._..........._.............._.....u..... .-.-. ................... ...-.. ................ Permit Number......... .-- .................. Address. .................... _un', ..--.......................................................... ......... . . ..__. Month....__ . ..-. .... .... ....-..... .... ,19.__.___m STATEMENT OF TAX DUE THE STATE OF WASHINGTON : FUEL ~ 1. Used on Washington Public Highways (Total Schedule 1,~Column E) 2. Exempted Use for Highway Construction and Maintenance 3. ExemPted Use bv an Urban Passenoer Transnortation System 4. Balance on Which Tax Is Due (Line I Minus Lines 2 and 3) - - - TAX, PENALTY, AND INTEREST S. Use Fuel Tax (Line 4 @ 9t) I $ 6. Penalty (10% of Line 5) 7_ Interest (~% of Line 5 ner Month Be"inninp on th;'21s-t~---. I : 8. Total Due for the Monlh (Lines 5 to 7) $ 9. Other Debits or Credits (Explain) 10. Remittance Payable to State Treasurer i $ - SCHEDULE 1 - COMPUTATION OF FUEL USED ON WASHINGTON PUBLIC HIGHWAYS , V1HICLl ID1NTlflCATlON I Seatln. ~_.~-----~~~~~~~~~--_.- G.llon. of II T".I Avo,ago '!,t,T UMd." C:ri~' Gallonlof htul WalhlnglOft Mil.. W.~r..~bIlC Woahlngt_ L1e'"M fuol Uloct Public P" Gollon I. D. N",mb.r HIghwoy. HIIftIlb,.. ~-- 1'1 lei 1'1 I" ---" -----_._- --. ---- ---- I -------- ----- f-----I- 1-..-1- -- f--. I ----; ---1----- i----r------. ____.__. ~ __J--- --.---- ----.-.--=1~---.-.--l ----------jl----- -- Tor.. I Ii . - i Submil rcpOl't with remittance 10: Slate of Washinglon. Deparln1ent of Motor Vehicles, Ll~Uid Fuel Tax Division, Ol~mpia. W"shin~lon, If ta. is nol paid on or bcfore the 20th day of the month, add pena ty and interest for delinquency as p...,,,idcd by Re"ised Code of Washinglon (RCW) 82.40.0RO. ~ o Check here if .his is il tinal report and enclose u~e fuel tux permit and I. D. Cards. ;;; , I. ot'/"J: duly mltJwriul/. Irt'reby {'ntif)' ,lUll tlris r~l'nrt i.I '0 the he.u of my knowledge tru~. correct, and ;;:. J ,'t.lI1,pIcIC ill aCC(Jr./lUlft' n';:1I dlapter 8~.40 RCW and Ql'pllcdhlc regulmlofu. ~ I Signature ,'-'---'.' .---...-. - ~.. Date. .... __..m__.' 19____._._.. I .. Title...... ..__ ._. n... -........ ....... Dated at .. .. ........ .........h.._......_.__. _.n........ , ';~:; ;,: :. ,:' :' ii,' ': ,.' '; ':', i'\,::::: "'i' '. " :: ..... , ...... i:',<'.' ;' ". '.. '. .... .;' ':.. '. :; , ,:',',.. ': ::/":" . . ". .- '.; '". ~. I , " "", , ",,' ''-, ' , '.. "..., ".,:. '. , ,,' ."'''. .' ..,., ',' '. " .'".,.'....'...' .' . ....::' '.', : ., '. .... , .' :~': . ..'.. .,', ,,':. .., ,,' '.';< : .,' .';' .. ',"; , , .,,:. ", .;" .' .'.:', ". , .:. .,. ,... ,,'. ... , ': 1 '-", .. SCHEDULE 1 _INSTRUCTIONS l. List each vehicle for which a Washington I. D. number is required. 2. Compute column 0 (Average Miles Per Gallon) to two decimal places by dividing column B by column A. 3. Compute column E (Taxable Gallons of Fuel) to the nearest gallon by dividing column C by column D. 4. Space is provided for ten vehicles, if more arc operated in Wash. use Schedule I (Supplement). Supply is availabel upon request. SCHEDULE 2 - DETAIL OF WASHINGTON FUEL RECEIPTS I: I (Service Station Receipts Only) INVOICE SELLER WASH. GAUONI I.D. INTO DATI HUMin NAM' LOCATION NUMBER VEHICLIS , , , I , TOTAL SCHEDULE 2 - INSTRUCTIONS I. Washington purchase Invoices in detaU must be listed by each vehicle. 2. The gallons listed lor each purchase Invoice should be carried to the nearest whole gallon. Use even gallons-<lo not show tenths. .. . . , , : .,:", < ;:'; .,., , ',:: \,' :." ',' . ,: '" ", ",.' , " . ': '"' ,:' :',: "',' ': ',:, :',', ,,,,, < ,;.':, ",.' "",' ,"'i::,.;:; ,".>,",; '", ,,,:,,, " I, , /, :, :':, " ',,::' :,': " ,.,'(" , ,'" ':':',., \: ,,'.' '.':; ,",:.:;'c':c',,":::' ,.', ,', '.. ,':'- >'! i: " ' ' , , .>::' I - . ." :. ,...-:<: :~... " " .". -'. . . .... ;... ..'. "<' ",<-; . ..' .. ... . . . ." .... ....... :'.', .', , ',,'.; ""'.;,. . . ". .:, ,\:. .,: ': . '. :.,:: ..' ',' ::.C' ~, .w, UF 97B . . STATE OF WASHINGTON DEPARTMENT OF MOTOR VEHICLES LIQUID fUEl TAX DIVISION USER'S USE FUEL TAX REPORT For State, Counties, Cities, and Urban Passenger Transportation Systems Name............. Permit Number........... Address. . ... .__.. Month.,.__ .__..,19.____.____ STATEMENT OF TAX DU~ THE STATE OF WASHINGTON FUEL 5. 6. 7. 8. 9. 10. TAX, PENALTY, AND INTEREST Use Fuel Tax (Line 4 @ 9t) Penalty (10% of Line 5) Interest ('1.1 % of Line 5 ocr Month Be.innin~ on the 21st) Total Due for the Month (Lines 5 to 7) Other Debits or Credits (Explain) Remittance Payable to State Treasurer $ 1$ SCHEDULE 1 - COMPUTATION OF FUEL USED ON WASHINGTON PUBLIC HIGHWAYS YlHICLf IDiNTlflCATlON II ~MllES TRAVELED W-"I"llr_ c:;i~!y ~:rr~':~f - ---;::;-----w~~i;;;- I. D. ~'=b:r HIgh....aY" -==____, I I~ --~--- - lei --~ ~--:~~1f~ . ------ I r----- --- ----.-- ----.1 ----, ---i,i,l:.------.-I TotAL 1'1 Gallon. af Fuol U.-d on W'"~?ecrt':lIbllc 1'1 .......rag. Mil.. p" Gallo" ~ Submit report with remittance to: Stnte of Washington, Department of Motor Vehicles, Liquid Fuel Ta. Division, Olympia, Washington, If tax is not paid on or belore the 20th day of Ihe month, ndd penalty nnd interest for delinqnency as provided by Revised Code of Washinglon (RCW) 82.40.080, o Check here if this is n lim,' report and enclose use fllel tax permit and I. D. Cards. I. h~i"1: tllll,~' mnhoriud. hnt'hy cerlify ,hat I1lis r,porl ;.r to tht! be.\'t 0/ my knowledge true, correct, and ('omplt/C ;n atl"orJmu"t' w;," dwpler 8~ .40 RelY and applicable regulmions. m '" ;:. Signature Date ....,19, s :; TiUe..._....... Onted at ';\" ':';.) .'.:' '.",. <<;', ."', ,"" ":',:,' "., ;. ;':': ':; .' .:. "', '." \' ,,'>. :;," .', ," ,';'; . :',' I,' ',I ."'::', ill '\ ,:;' ., :.i :: , ''''. .:....,.'... '" <,.,;' , ,', ',:' ( " "', ",.' "". '",' :,: , ' '" ., :..', " " ,., '. ,1',',,:":"\;" "" ,< /'~ '. . .' . ,. ......... ..', .. .., .... . ',' .',' ',' /,.' . " ... '.,'; . ,.',.:: :", " '.', i" . ..' '. ," ".:' ',,' ~:..i "i: ", '. ' ,.,.., ' :'., ., d ,.',"'.", ,." ," ;', '.. .',:, '.. "., ':'. i,' 'J , ' ,'" 'i,'" SCHEDULE 1 - INSTRUCTIONS 1. List each vehicle for which a Washington J. D. number is required. 2, Compute column 0 (Average MUes Per Gallon) to two decimal places by dividing column B by column A. 3. Compule c:oIumn E (Taxable Gallons of Fuel) to the nearest gallon by dividing column C by column D. 4. Space is provided for ten vehicles, if more are operated in Wash. use Schedule 1 (Supplement). Supply is avaUabel upon request. SCHEDULE 2 _ DETAIL OF WASHINGTON FUEL RECEIPTS (Service Slation Receipl3 Only) DATE NUMIEI HAM' LOCATION WASH. I.D. NUMBER GAUOOII INTO' VEHlaB INVOICE SELLER ! , i , '. , ,,' " I' TOTAL SCHEDULE 2 - INSTRUCTIONS 1. Washington purchase Invoices in detaU must be listed by each vehicle_ 2. The gallonslis.ed for eaeh purchue Invoice should be carried to .he nearest whole gallon. Use even gallons-do no/ show Un/h.!. . . '"'''' '",' :.' .-: ,;:: '., ., " ,'" ,: " ' " ,." ,"';\:i\ ... ,:.'."; ,"", 'i.., ", '':'" "',", , " " ,. ,'.', '. ,:,'" '.. ,:, ::' : " '-"',,',;, ','': ,'>, '" "" ,,,,,: :,' "" ',,','< ',..,.,. ," .' .,', ' ,"', .',,' ',' ;.i, : ',::;:}. , ' , ... ": ,.,' ,'" .""', ':;'-< , ,,: ::'.,:", ,.'Y','::,.,::' ,,, \, " "'. ,...... .: .' ...... ..... . . .... . .'. ....... , .... :":: " " "">'...' .: .,,', ..".,:. ,'" ,.., ',' ./ .,. '.. ., .,' . .,.'.,.' .' .. . ,'d, , .'..,......., .:. '\'.'.' . ': '.. .,:', .:.: .' . . ' . .',:.. . ,-' .... .. . . .:.,.', ".: . ,':,:.' .,' .,,-..,' " ." '-;'-:'. :';:; UF 978 . . STATE OF WASHINGTON DEPARTMENT OF MOTOR VEHICLES UQUID FUEL TAX DIVISION USER'S USE FUEL TAX REPORT For State, Counties, Cities, and Urban Passenger Transportation Systems Name.......... ._ .... Permit Number.. Address --. dH.H.H . .H' H..H. Month. '__ .._.,19..... _... STATEMENT OF TAX DUE THE STATE OF WASHINGTON FUEL J. Used on Washington Public Highways (Total Schedule I, Column E) 2. Exempted Use for Highway Construction and Maintenance 3. Exempted Use by an Urban Passenger Transportation System 4. I!alancc on Which Tax Is Due (Line I Minus Line, 2 5. 6. 7. 8. 9. 10. TAX, PENALTY, AND INTEREST Use Fuel Tax (Line 4 @ 9~) Penalty (10% of Line 5) Interest (~% of Line 5 per Month Be-inning on the 21st) Total Due for the Month (Lines 5 to 7) Other Debits or Credits (Explain) RemiuancePayablc to State Treasurer $ 1$ SCHEDULE I-COMPUTATION OF FUEL USED ON WASHINGTON PUBLIC HIGHWAYS 'I ~l ."m TRAV"', lolal ,._..._____~:---- Gollon, of WOlhlnglOfl I f....1 Uled . 10101 J .....bllc HJahwoYf. 'AI III Ie) -rr--- ----- ,-1---- -11 . ~ L----1 - . f--. F-===I , 1.----.-- --.-.-- .---.-- --1 --+---- -.--- --.-_..- --- ------.--)I-.--.-~ 10'AL !I VEHICLE IDENTIfICATION WU"""II'" I. D. N.....' L1e,t... Nul'lllN, hotlnll c:r:~:r "".fIlS_ Mil,. ,., 00110" OallOfl' ., Fu.IU...._ Wa"tlililt::.r:ubllc t'l ,., I I --___J ~ I Submit rcpoll wilh remittance to: State of Washinglon. Deparlment nl Motor Vehicles, Liquid Fuel Tax Division. OIYll1phl, W:tshington. If tax is not paid on or before the 20lh dilY of the month, ndd penalty and interest for delinquency,,, providcd by Revised Code of Washington CReW) 82.40.080, o Check her. il this is a final report and enclose use luel lilX permit and J. D. Cards. I, hdng duly tlllIlltlriud. ht'rtby ftrlify that this Uf'ort i.r to tilt ht'.ft of my k"olt'lcdg~ true, correct, and ('()H,pltlc itr Qc'cordm,cf: with clWPfr.f 8J.40 new and tJpplicable rtglllmiollS. ~ ;;; .. "," Signature Dale .--.__....,19.......___ ~ .. Titl.............. . Dilled at. ... ",' :,1 ".,.: :' . . , '" .. ':,: ~;: ,..: .' ." .': ".,'.:'.",: :"',:' '1' ,',.: :'.""':.'::'.",. :"., '.'<:':' '.', ...., '.::.;, , ',:..' ," " ,.' ". '. ': .'.;'.' ~J 1.'~ : '. , .'.... :. ..., ':'. "c,,'.'" ,'::..' .'. .,,'''',,': . ,--:. .':'.':':,.,. .,'. :"". ::: '. .... ,. .... ," . ... ..: ,', '. ,. ' " '. '..,' ," . :'. ,.' >':' .... . . '. .". ""', . .,', """'" :,', :,: :.'.: . "~I. :" '. "'. .,;'.. .. ',: ..., :; '.:. ..,' ',: . '-'. . : .." ~ SCHEDULE 1 - INSTRUCTIONS I. List each vehicle for which a Washington I. D. number is required. 2. Compute column D (Average Miles Per Gallon) to two decimal places by dividing column B by column A. 3. Compute column E (Taxable Gallons of Fuel) to the nearest gallon by dividing column C by column D. 4. Space is provided for ten vehicles, if marc are operated in Wash, use Schedule I (Supplement). Supply is availabel upon request. SCHEDULE 2 - DETAIL OF WASHINGTON FUEL RECEIPTS (S~rv/ce Stalion Reel/pIS Only) DATI HUMin NAM' LOCATION WASH. I.D. NUMBER GAu.oNI INfO VEHIClIS INVOICE SELLER .. .' TOTAL SCHEDULE 2 -INSTRUCTIONS I. Washington purchasc Invoices In detail must be listed by each vehicle. 2. The sallons listed for each purchase Invoice should be carried to the nearest whole gallon. Use even ga!1ons--dn nor show un/hr. . . ,'. I , \, '., ,::' :: '.,:,: ,::',"" " ,,'" ';',' '" . -- ':, ' c,' , . , ' , .' . '. ~ , ". '\, '. ',' '.,', .. .',' , , >;';',;:',;' :,,'.,:,'. ,:',' '.' ,',,".': :". .,.....' .':. :;:ii ',,'. \', '." , :,.. . "":', ..: " '." .': .,:. ....:" " :, .", ,..., " ::..: J .... ::., :: . '.'" ': ::..: .;,..,. ..." ,,'. .';.','.' ,. '" . :.:.:..'.',,"; ;. .:;....,..... ~~':~~;~ .: ".,' . ". .::.." .; . .'.> .'. " :.'.:': "'. \ ':" ;' .', . '.. " .... '. ',', ;.,' <: . '.'. .,', ':',: :. '.: .": !; UF 978 . . STATE OF WASHINGTON DEPARTMENT OF MOTOR VEHICLES LIQUID FUEL TAX DIVISION USER'S USE FUEL TAX REPORT For State, Counties, Cities, and Urban Passenger Transportation Systems Name........................................ _n. Permit Number......... Address . .u.u.__.. Month. .__ ,19.......... STATEMENT OF TAX DUE THE STATE OF WASHINGTON FUEL I. Used on Washington Public Highways (Total Schedule I, Column E) 2. Exempted Use for Highway Construction and Maintenance 3. Exempted Use by an Urbao Passenger Transportation Svslem 4. Balance on Which Tax Is Due (Line I Minus Lioes 2 and 3) TAX, PENALTY, AND INTEREST 5. Use Fuel Tax (Line 4 @ 9t) 6. Penalty (10% of Line 5) 7. Interest (~% of Line 5 per Mooth Beninnioll on the 21';;) 8. Total Due for the Month (Lines 5 to 7) 9. Other Debits or Credits (Explain) 10. Remittance Payable to State Treasurer $ 1$ SCHEDULE 1 - COMPUTATION OF FUEL USED ON WASHINGTON PUBLIC HIGHWAYS VIHICU IDINflflCATlON 'I I MILU TlAV.u~D W-'ailtgt. I l:ii:t I ~:I~:~::df ~ - --~=---I wa:~i,~ton -- H:;':" N=' (AI III Hra~qaY' -~.=---i I~--=-- ---. I - I --+--~--- ---- ---r---=ll if' ..---.- ---- .....J__ ------ ---i 1._- -.---- ---=r~L--+---- -----l.---.----- Awo'IQII' Mil" p" Gall.,. Oollon. .f 'u,1 UMd OIl Wa.~ru'C:.:lfbllc ('1 1'1 ~~ Submit report with remitlnnee to: State of Washington, Department of Motor Vehicles, Liquid Fuel Tax Division. Olympia. Wnshin~ton. If lax is not paid on or before the 20lh day of the month, odd penalty and IntereSI for delinqnency ., provided by Revised Code of Washington (RCW) 82.40.080. o Check here if this is a tinal report .nd enclose use fuel 11" permit and J. D. Cards. " h~iflg ,lllly fIlolwriu.I, /ttrth." rcrti/)' that tlrls r,."ort i.f 10 tht' he,tt 01 my knowltdge trut, correct, and C'ompltlt' in tl('("ordtlllft' with dllJpltr 8~.40 RCW and UI'l'ticub/e ftGulalimu. ~ is ... " ",. Signature ~ .. Dme ...m..,19m,,__m Title............__ Daled at "" ,:,'.,,<,,' ::. ';", .... ':-'.: ;::> ,."..,. ' ;,/':'" ':.~:" <":., : "': :. :>': ,'; ::;\'::',. \ .,' " ;::,,,,, '.: ..'>, , i", :.' " ,,/' :,":' , '~ ',( ':,\, '. :' "'.;, '. '. " ',:. ." ':: '. ::.':,.-;:, , ,,-,,,, ,; , ':':'" ':'" ! , :: ." . ~."J .~ . 'J .,: ,; ,',' ,.,,' '", '.-':.: '. , "', ::,.i, ':':, .: ,., , .. :'. ':.- : ". :. '", ", ,,', ','" . " . , " '" . '. .': '-, , . ,"', , ': ','. ,:,' ,," ",. ",':' .' '", " ,". "'>--:' ',,' ',::: . . ,.',' , ,:. ,'.,'",',", "":' '"".. '"', '\.,' ",.. . , , . ';':" . :' . " : >;" ,. .<::> " H: SCHEDULE 1 - INSTRUCTIONS 1. List each vehicle for which a Washington I. D. number is required. 2. Compute column D (Average Miles Per Gallon) to two decimal places by dividing column B by column A. 3. Compute column E (Taxable Gallons of Fuel) to the nearest gallon by dividing column C by column D. 4. Space is provided for ten vehicles, if more are operated in Wash. use Schedule I (Supplement). Supply is availabel upon request. SCHEDULE 2 - DETAIL OF WASHINGTON FUEL RECEIPTS (Sendee Slallon Receipts Only) INVOICE SELLER WASH. I. D. NUMBER DAn HUMin NAM' LOCATION TOTAL GAUONI INTO VEHICI.IS SCHEDULE 2 - INSTRUCTIONS I. Washington purchase Invoices in detail must be lilted by each vehicle. 2. The 8allons lilted fOf each purchale Invoice Ihould be carried to the nearest whole 8allon. Use even 8allons--do nol show renths. . . :.', , ,,7 . """ ;" ',. :', " "::: ,'" ,', , " ,<,', :,: ',., ",,' " , :, ' ': ,.','" ,', /':" ,,' ,,:, "':.-':' : ',:.0 ."" .,',' ':, ','. ",< '" ::' "", "" ':, ,,", ',' :',," ,;' '" ::,' ':"'.:',,.'. , ',:', ",., ",'", ,:, ;','-' :: ~:'::,' ":",' ,,,:,.... ",,'<,,', ':" ,;,':j'.., " " "," , ': '" '. "'-- ,.,,;,1': ;':::;'Y, " , .' , -- ,: . ":'" ; ,,; ': , . .- , I oiOot...LJ' l......... ..'c,. .', '" ., -,:",:,. ,:'.' C'.' ,::'- ',>> '., :-".,':,'., ,."..' ,.. ,',' ,',., .' , . ' ."'" ., '.., , ", , ' . ,. '.',: , :: :', .".".':', " -, ',',. ,: ~ .' ',,' . ,-' , ' ',' . .. ,,~III :',. .-'., , :,'.,'< < "', ,,'J,: ".". ,.. ., ",.., ,': 'c .' , . '.,:-'.",'" ..::" ",:'",:".'. '.,::,". . ", ,',:, ,,"'," ", , ./ .. .", ",.', ".: '., ,.' ,,", .', " ,.;: --'," ':., . " . DEDUCTION DETAILS . ~IF MORE $""CE IS NEEDEO, ATTACH SEPARAte SHEETSl SCHEDULE A _Gallons used on Washington public roads in motor vehicles exempt by statute from special fuel tax. (see Instruction sheet). Claim crealt or gal,lons 0 spec 81 Tuel used on Washington public roads while operating: (A) Motor vehicles using propane or natural gas. (B) An urban transportation system over a prescribed route within a 25 mile radius of corporate county rimits. VEHICLE OR FLEET NU"UIU! TOTAL GALLONS DELIVERED INTO VEHICLES GALLONS USED ON WASHINGTON PUSLIC ROADS GALLONS SUBJECT TO CREDIT DIESEL OTHER (100%) ====J!~~[==== ======== (100%) ----(100%)---- --------- ----(100%)~--- -------- ----(100%)---- -------- -----(100%)---'- -------- -----~OO%)---- -------- CARRY TOTAL. ROUNDED TO NEAREST WHOLE GALLON, TO LINE 7 TOTAL GALLONS __ Gallons used in Washington to operate power pumping units or power take-off equipment (a) on de)ivery trucks pumping propane, SCHEDULE -B- {~~~ ~;~r~~troe~t~~e~;~s or (b) for other purposes it motor vehlclo is equipped with a metering device approved by the department. Claim credit for three~fourths of a gallon for each 1000 gallons pumped. Exs'mple: (140,000 x .00075 = 105 credit gallons) VEHICLE OR FLEET NUMaER OELIVER,. ~ETER REAOINDS TOTAL GALLONS PUMPEO GALLONS SUBJECT TO CREOIT DIESEL OtHER -------------------- -------------------- ----------- (.00075) ----(:00075)---- ----(:00075)---- ----(:00075)---- --- -(.00075)---- ----{.COO7s)'---- - - --(.00'075)- --- ----(.00075)---- -------------------- -------------------- ----------- -------------------- -------------------- ----------- -------------------- -------------------- ----------- -------------------- -------------------- ----------- -------------------- -------------------- ----------- ... CARRY TOTAL. ROUNDED TO NEAREST WHOLE GALLON. TO LINE 8 (A). -------------------- --------------------- ----------- TOTAL GALLONS __ 'SCHEOULf:~ C.. '':;:I~,a used In Washinglon to operate a power take-oll unit on cement mixer trucks and load compactors on garbage trlJCk,s. (see Instruction Claim credit 10r 25~' of the gallons of special fuel used in Washington. Example; (3000 gallons x .25 .. 750 credit gallons) VtHICU:OA FLEEThlU~OEA 'OtAL GALLOfoI& O[LIVfR[O l"Iro V[H~.LES I,!ILfS,AAVHfO IN WASHINGTO"l GALLONS USED I'" WASHINOTON R"n OALLONS SUBJECT TO CREDIT OICSfl OTHER CARRY TOTAL, ROUNDED TO NEAREST WHOLE GALLON. TO LINE 8, (0) __u_i.~.L____ . (.") U - n i.is, _ n__ -- -Ui..siU n_ n-n(:i.,---u -----i.25'----- n---i.i.,--n- _u - -i.i., __n_ TOTAL GALLONS_ ----------- ----------------- ----------------- ----------------- ----------- ----------------- ----------------- ----------------- ----------- ----------------- ----------------- ----------------- ----------- ----------------- ----------------- ----------------- ----------- ----------------- ----------------- ----------------- ----------- ----------------- ----------------- ----------------- ----------- ----------------- ----------------- ----------------- file 'hll rtf)Of1 ."et Nft't.Il'."ce Wl1h ,,,. Sllle 01 WU/'IInglon. Dap.rtmllnl 0' Molar Vot!lclel, '-uol 1.. DIVlllon, P,O BOX 2228, OlympI.. WlIshlnglon 08504 AVOID PENM. TIES ""po", .", dVtl on Of bf:lonl m. ~5th day 01 the monlh lonowlng UIll A charge a' 10 porcent plllf Intores' II Ihft flltfll 01 1 ptr,cenl per monlh 01 lhe 1111 dUCt will be a......a for ..I'e ft"porll D,'ecl .nQu""fI'l 10 Ull't ruet T.I. 01"'1110" Of Te!ephonft {O'OOI 753.6900 DISTRIBUTION. ORIGINAL; To DePJIr1mttnt or Molor V"hlClflS DUPLICATE: SPKlal fuol U5~r', copy .~- :.';.... ..' ::,'. ,,' " , ,,\,: .'" .....: " " "'.," . ", ' .,..',' , , ,. '.';.' . .' ....': ':. i , ",::. ....':,:' , , , : ~ ." , c"";",.,'":,, ' " ':,', ".'" ',," " ',:"," : ,r', ,',,,,':' ',,' , ", ,. .': .' . :.; ., , "" , " "i':: '.:, ";',: :, . ,. , '.," .,' iio..o...~. ~~ .........," ~'>i ",,--,-.,' L..' iLor.....,_.l w '" 0: 0. '" N .; N ::; w is ,- ",,- ~~ ",0 ~ O:l." Zt- :3'WW WZ U;:I:. c:.::l (.J:t: ~a '-'IlJ.!:J :=1.1: .J(C:'Z u.r "'::> ;:)~I- ""I-lZ~') Q:JC) ;...;z:o..... i-LlJU.-f ':!;~CJ-I ':J'X~, OilJ C'~ U 00.... 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J J .. .. 631.10.47 PUBLIC UTILITY SERVICE 631.10.48 REPAIRS AND MAINTENANCE 631,10.50 INTERGDVERNMENTAL SERO .. 800.00 8000.00 11000.00 806.39 2787.25 5900.00 2000,00 13000,00 10000.00 . 1000.00 5000.00 5000.00 ---------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------- 104,720,00 91,566.47 116,425.00 -0- 92,500.00 TRANSFER SWOROP SITE 1983 BUDGET 1983 1984 ACTUAL BUDGET 1984 1985 JAN-OCT BUDGET ---------------------------------------------------------------------------------------------- 632.10.11 SALARIES AND WAGES 33230,00 30392,94 43575.00 49350,00 632.10.12 OVERTlNE HAZARDDUS DUTY 1000.00 12110 00 1000.00 1200.00 632.10.16 LONGEVITY 360,00 148.06 360.00 360.00 632.10.21 PERSONNEL BENEFITS 7090.00 7271.53 13072.50 9200,00 632.10.28 UNIFORM AND CLOTHING 0.00 38.71 100.00 100.00 632.10.31 OFFICE I OPERllTING SUPPlIES 2000.00 4027,92 5000.00 4000.00 632.10.42 COMMUNICATIONS 0.00 0,00 0.00 600.00 632.10.47 PUBLIC UTILITY SERVICE 0.00 642.47 0.00 1500,00 632.10.48 REPAIR AND MAINTENANCE 0,00 13D.93 0,00 0.00 632.10.49 MISCELLANEOUS 580,00 302.07 250.00 250.00 632.20.11 SALARIES AND WAGES 22450,00 16854.28 23136.25 22820,00 632.20.12 OVERTIME HAZARDOUS DUTY 600,00 562.80 1000.00 600,00 632.20.16 LONGEVITY 0.00 330.00 360.00 360,00 632.20.21 PERSONNEl BENEFITS 6170,00 4640.82 6940.87 6900,00 632.20.31 OPERATING SUPPLIES 0,00 4357.14 2000.00 5000,00 632.20.45 EGUIPMENT RENTAL 0,00 4070.00 2000.00 4500.00 632.20.48 REPAIR AND MAINTENANCE 0.00 5625.59 3500.00 5000.00 632.20.49 MISCELLANEOUS 5000,00 1302.96 1012.26 1000,00 632.50.31 OFFICE I OPERATING SUP 4500.00 572.00 1000.00 500,00 632.50.45 EOUIPMENT RENTAL 0.00 125.00 0.00 0.00 632.50.47 PUBLIC UTILITY SERVICE 1800.00 1096.39 1800.00 0.00 632.50048 REPAIR AND MMNTENANCE 4500.00 2643.75 5000.00 4000,00 ---------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------- 89,280.00 86,346.36 111,106.88 -0- 117,240.00 GENERAL AriMINISTRATlON 1983 1983 1984 1984 1985 BUDGET ^CTUAL BUDGET JAN-OCT BUDGET -------------------------------------------------------........-----...-----..------...------------- 637.10,11 SAL^RIES ^ND W^GES 637.10.21 PERSONNEl BENEFITS 637.10041 PROFESSION^L SERVICES 637 . 30,31 OFF! CE I OPERATI NG SUP 637.30,42 COMMUNICATIONS 6000,00 420.00 0,00 200.00 100,00 4857.97 834.47 0.00 66.89 21.35 5706.25 1711.87 0.00 100,00 50.00 0.00 0,00 7750.00 100.00 100.00 ======:c=======::====================================:=========================================== 6,720.00 5,780.68 7.568.12 5,706.25 7,950,00 . . SALARIES AND BENEFITS PORTION 1963 1963 1964 1964 1965 !iUDGH ACTUAL BUIIGET JAN-OCT BUIIGET ---,.----------------------------------------------------------------------------------------- SANITARY LANDFILL 631.10.11 SALARIES AND'WAGES 54260.00 61922.44 62250.00 59200.00 631.10.12 OVERTIME HAZARDOUS DUTY 200.00 135.00 0.00 0.00 631.10.16 LONGEVITY 360.00 0.00 0.00 0.00 631.10.21 PERSONNEL 6EtlEFITS 13000.00 14517.66 16675.00 14300.00 TRANSFER ST AlDROP BOX 632.10.11 SALARIES AND WAGES 33230.00 30392.94 43575.00 49350.00 632.10.12 OVERTIME HAZARDOUS DUTY 1000.00 1211.00 1000.00 1200.00 632.10.16 LONGEVITY 360.00 146.06 360.00 360.00 632.10.21 PERSONNEL BENEFITS 7090.00 7271.53 13072.00 9200.00 632.20.11 SALARIES AND WAGES 22450.00 16654.26 23136.25 22620.00 632.20.12 OVERTIME HAZARDOUS IIUTY 600.00 562.80 1000.00 600.00 632.20.16 LONGEVITY 0.00 330.00 360.00 360.00 632.20.21 PERSONNEL BENEFITS 6170.00 4640.82 6940.67 6900.00 GENERAL ADMINISTRATION 637.10.11 SALARIES AND WAGES 6000.00 4857.97 5706.25 0.00 637.10.21 PERSONNEL BENEFITS 420.00 834.47 1711.67 0.00 ============================================================================================ 145,140.00143.676.97177,767.24 -0- 164,290.00 OFFICE AND OPERATING SUPPLIES PORTION 1963 BUDGET 1983 1964 ACTUAL 6UDGET 1984 1985 JAN-OCT BUDGET --------------------------------------------------------------------------------------- SilNITARY LANDFILL 631.10.31 OFFICE & OPERATING SUP 16700.00 5150t73 10000.00 7500.00 TRANSFER ST AlDROP P.QX 632.10.31 OFFICE ! OPERATING SUPPLIES 2000.00 4027.92 5000.00 4000.00 632.20.31 OPERATING SUPPLIES 0.00 4357.14 2000.00 5000.00 632.50.31 OFFICE & OPERATING SUP 4500.00 572.00 1000.00 500.00 GENERAL ADMINISTRATION 637.30.31 OFFICE! OPERATING SUP 200.00 66.69 100.00 100.00 ============================================================================================== 23,400.00 14,174.66 16,100.00 -0- 17,100.00 EDUIPMENT RENTAL PORTION 1983 BUDGET 1963 1984 ACTUAL BUDGET 1984 1965 JAN-OCT BUDGET ----........--..----..------........-----...-------...--------..------------------------------------------- TRANSFER STATION 632020.45 EQUIPMENT RENTAL 632.50.45 EQUIPMENT RENTAL 0.00 4070.00 2000.00 0.00 125.00 0.00 4500.00 0.00 ::::=:a::===:S:lI=::::=:::::::=::n::::=::==:::::=:===================::===:::=====:==========:=::=========::::= -0- 4,195.00 2,000.00 -0- 4,500.00 . COMMUNICATIONS AND UTLITIES PORTION . 1983 1983 1984 BUDGET. ACTUAL BUDDET 1984 1985 JAN-DCT FUDDET -------------------------------------------------------------------------------------------- SANITARY LANDFILL 631.10.42 COMMUNICATIONS 400.00 303.47 400.00 400.00 631.10.47 PUFLIC UTILITY SERVICE 800.00 806. 39 2000.00 1000.00 TRANSFER ST AfDROP FOX 632.10.47 PUBLIC UTILITY SERVICE 0.00 642.04 0.00 600.00 632.50.47 PUBLIC UTILITY SERVICE 1800.00 1096.39 1800.00 1500.00 DENERAL AI'MiNISTRATION 637.30.42 COMMUNICATIONS 100.00 21. 35 50.00 100.00 ============================================================================:::================:::= 3,100.00 2,869.64 4,250.00 -0- 3,600.00 REPAIR AND MAINTENANCE PORTION 1983 8UDGET 1983 1964 ACTUAL BUDDET 1984 1985 JAN-OCT FUDDET ------------------------------------------------------------------------------------------- SANIHRY LANDFILL 631.10.48 REPAIR AND MAINTENANCE 8000.00 2789.25 13000.00 5000.00 TRANSFER ST AfDROP BOX 632.10.48 REPAIR AND MmTENANCE 0.00 130.93 0.00 0.00 632.20.48 REPAIR AND MAINTENANCE 0.00 5625.59 3500.00 5000.00 632.50.48 REPAIR AND MAINTENANCE 4500.00 2643.75 5000.00 4000.00 ----------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------- 12,500.00 11,189.52 21.500.00 -0- 14,000.00 MISCELUlNEOUS 1983 BUDDET 1983 1964 ACTUAL BUDDET 1984 1985 JAN-OCT BUDGET --------------------------------------------------------------------------------------------- EXPENDITURES 502.92.34 ITEMS PURCH^SED FOR RES^LE 0.00 13586.24 10000.00 12000.00 FIXED ASSET PURCHASES 630.32.44 ADVERTISING 0.00 438.40 500.00 0.00 630.32.63 IMP NOT BUILDINDS 233000.00 209578.84 80000.00 0.00 SIINITIIRY LANDFILL 631.10.50 INTERGOVERNHENTAL SERV 11000.00 5900.00 10000.00 5000.00 DENER^L ^DMINISTR^TION 637.10.41 PROFESSlONiIl SERVICES 0.00 0.00 0.0 7750.00 GRltNTS 638.30 GRltNT REIHBURS^BLES 0.00 0.00 0.00 24000.00 638.90 DRltHT ^DMINISTRmON . 0.00 0.00 0.00 1000.00 NON-EXPENSE REIMBURSEMENTS 639.12 REPMHENT OF LO^HS 0.00 0.00 0.00 135000.00 ==::=: :==:::r: ::::= ::=:: =:z::: ====:: = =:= = ==:=:==== ::=:: === == = === ==:: =::::::: == ===:=::: ::: ::::::::<:; ====<:;:: === 244,000.00 229,503.48 100,500.00 -0- 184,750.00 . 1983 BUDGET HEVENUE 1983 tiCTUnL . 1984 BUDGET 1984 JtiN-OCT ----------------------------------------------------------------------------------------------- 1985 BUDGET 311.10 ~ ~ ~ ~ "'. 0 395.10 401.00 431.10 431.90 433.20 434.30 1ZI;;.12 ~ QO 0.00 0.00 187300.00 lE.OOO.OO 9.ea 14.15 ~33.17 0.00 o 6.99 0.00 11.90 0.00 18327.60 0.00 0.00 141181.96 LY~8o.o0 8.&6 85600.00 0.00 0.00 200000.00 0.00 0.00 40000.00 v.Vv v.uo C).Of) 0,00 19~/OCO I"~ LJ.6 1Z.)~'ao G .&lOi =============================================================================================== 433.720.00 302,009.43 325,600.00 EXPENDITURES 1983 BUDGET EXPENSE 1983 ACTUAL 0.00 13586.24 10000.00 1984 BUDGET 1984 JAN-OCT -0- -0- 1985 BUDGET 502.92.34 ITEMS PURCHASED FOR RESALE ----------------------------------------------------------------------------------------------- 12000.00 4-' =============================================================================================== -0- 13,586.24 10.000.00 -0- 12,000.00 FIXED ASSET PURCHtiSES '* IIJFOfUnAnolU NDT A-"mr..A&.E' 1983 1983 1984 1984 1985 BUDGET tiCTUtiL BUDGET JAN-OCT BUDGET 630,32.44 ADVERTISING 630.32.63 IMP NOT BUILDINGS ----------------------------------------------------------------------------------------------- ~ 0.00 0.00 438.40 500.00 233000.00 209578.84 80000.00 =================================~============================================================= 233.000.00 210.017.24 80,500.00 1983 BUDGET SANITARY LANDFILL 1983 ACTUAL 1984 BUDGET -0- 1984 JAN-OCT 500.00 ----------------------------------------------------------------------------------------------- 1985 BUDGET 631.10.11 SALARIES AND WAGES 631010.12 OVERTIME HAZARDOUS [IUfY 631.10.16 LONGEVITY 631.10.21 PERSONNEL BENEFITS 631.10.28 UNIFORM AND CLOTHING 631.10.31 OFFICE & OPERATING SUP 631.10.42 COMMUNICATIONS 631.10.47 PUBLIC UTILITY SERVICE 631.10.48 REPAIRS AND MAINTENANCE 631.10.50 INTERGOVERNMENTAL SERV 54260.00 200.00 360.00 13000.00 0.00 16700.00 400.00 800.00 8000.00 11000.00 61922.44 135.00 0.00 14517.66 43.53 5150,73 303.47 806.39 2787.25 5900.00 62250,00 0.00 0.00 18675.00 100.00 10000.00 400.00 2000.00 13000.00 10000.00 59200.00 0.00 0.00 13250.00 "66.0. 7500.00 400.00 1000.00 5000.00 5000.00 . . --------------------------------------------------------------------------------------~-------- ---.------------------------------------------------------------------------------------------- 104,720.00 91,566.47 116,425.00 -0- 91,350.00 TRANSFER STA/DROP SITE ----------------------------------------------------------------------------------------------- 198:1 BUDGET 1983 ACTUAL 1984 BUDGET 1984 JAN-OCT 1985 BUIIGET 632.10.11 SALARIES AND WAGES 33230.00 30392.94 43575.00 49350.00 632.10.12 OVERTIME HAZARDOUS DUTY 1000.00 1211 .00 1000.00 1200.00 632.10.16 LONGEVITY 360.00 148.06 360.00 360.00 632.10.21 PERSONNEL BENEFITS 7090.00 7271.53 13072.50 7200.00 632.10.28 UNIFORM AND CLOTHING 0.00 38.71 100.00 /()()"OO 632.10.31 OFFICE & OPERATING SUPPLIES 2000.00 4027.92 5000.00 4000.00 632.10.42 COMMUNICATIONS 0.00 0.00 0.00 600.00 632.10.47 PUBLIC UTILITY SERVICE 0.00 642.47 0.00 1500.00 632.10.48 REPAIR AND MAINTENANCE 0.00 130.93 0.00 0.00 632.10.49 MISCELLANEOUS 580.00 302.07 250.00 24>".0>- 632.20.11 SALARIES AND WAGES 22450.00 16854.28 23136.25 22820.00 632.20.12 OVERTIME HAZARDOUS DUTY 600.00 562.80 1000.00 600.00 632.20.16 LONGEVITY 0.00 330.00 360.00 360.00 632.20.21 PERSONNEL BENEFITS 6170.00 4640.82 6940.87 6900.00 632.20.31 OPERATING SUPPLIES 0.00 4357.14 2000.00 5000.00 632.20.45 EOUIPMENT RENTAL 0.00 4070.00 2000.00 4500.00 632.20.48 REPAIR AND MAINTENANCE 0.00 5625.59 3500.00 5000.00 632.20.49 MISCELLANEOUS 5000.00 1302.96 1012.26 1000.00 632.50.31 OFFICE & OPERATING SUP 4500.00 572.00 1000.00 500.00 632.50.45 EQUIPMENT RENTAL 0.00 125.00 0.00 0.00 632.50.47 PUBLIC UTILITY SERVICE 1800.00 1096.39 1800.00 0.00 632.50.48 REPAIR AND MAINTENANCE 4500.00 2643.75 5000.00 4000.00 =============================================================================================== 89,280.00 86,346.36 111,106.88 -0- 114,890.00 GENERAL ADMINISTRATION 1983 BUDGET 1983 ACTUAL 1984 BUDGET 1984 JAN-OCT 1985 BUIIGET ----------------------------------------------------------------------------------------------- 637.10.11 SALARIES AND WAGES 6000.00 4857.97 5706.25 6000.00 ~7'10'21 PERSONNEL BENEFITS 420.00 834.47 1711.87 1740.00 637.30.31 OFFICE & OPERATING SUP 200.00 66.89 100.00 100.00 637.30.42 COMMUNICATIONS 100.00 21.35 50.00 I()D.~~ ~~==p~;i~;:::;::================~:;;~:~~===;:;~~::~===;:;:~:~;======:~:====;:~~~:~~===== ~ 'it""""'}S "... OoDld ~~Cl:;J -6~ ~s:;"P>' TOTALS 1983 BUDGET 1983 ACTUAL 1984 BUDGET 1984 .IAN-OCT 1985 BUDGET ---------~------------------------------------------------------------------------------------- 502.00 EXPEND ITURES 0.00 13586.24 10000.00 12000.00 630.00 FIXED ASSET PURCHASES 233000.00 210017.24 80500.00 500.00 631.00 SANITARY LANDFILL 104720,00 91566.47 116425.00 91350.00 632.00 TRANSFER STA/DROP SITE 89280,00 8/,346.36 111106.88 114890.00 637.00 GENERAL ADMINISTRATION 6720.00 5780.68 7568.12 7840.00 =;=~==o====;=~;~==~,=~=~~=====~===~~=~:~~============~=======================~==============c=== 433.720.00 407.296.99 325,600,00 -0- 226,580.00 . . SALARIES AND BENEFITS PORTION ----------------------------------------------------------------------------------------------- 1983 BUDGET 1983 ilCTUAL 1984 BUDGET 1984 JAN-OCT 1985 BUDGET SANITARY LANDFILL 631.10.11 SALARIES AND WAGES 54260.00 61922.44 62250.00 133360.40 59200.00 631.10.12 OVERTIME HAZARDOUS DUTY 200.00 135.00 0.00 0.00 631.10.16 LONGEVITY 360.00 0.00 0.00 0.00 631.10.21 PERSONNEL BENEFITS 13000.00 14517.66 18675.00 ~O /~.ila1. TRANSFER STA/DROP BOX 632.10.11 SA~ARIES AND WAGES 33230.00 30392.94 43575.00 49350.00 632.10.12 OVERTIME HAZARDOUS DUTY 1000.00 1211.00 1000.00 1200.00 632.10.16 LONGEVITY 360.00 148.06 360.00 360.00 632.10.21 PERSONNEL BENEFITS 7090.00 7271.53 13072.00 ~ 632.20.11 SALARIES AND WAGES 22450.00 16854.28 23136.25 22820.00 632.20.12 OVERTIME HAZARDOUS DUTY 600.00 562.80 1000.00 600.00 632.20.16 LONGEV ITY 0.00 330.00 360.00 360.00 632.20.21 PERSONNEL BENEFITS 6170.00 4640.82 6940.87 6900.00 GENERAL ADMINISTRATION 637.10.11 SALARIES AND WAGES 6000.00 4857.97 5706.25 6000.00 637.10.21 PERSONNEL BENEFITS 420.00 834.47 1711.87 1740.00 -------------------------------------------------------.---------------------------------------- ----------------------------------------------------------------------------------------------- 145,140.00 143,678.97 177,787.24 133,360.40 168,980.00 OFFICE AND OPERATING SUPPLIES PORTION ----------------------------------------------------------------------------------------------- 1983 BUDGET 1983 ACTUAL 1984 BUDGET 1984 JAN-OCT 1985 BUDGET SANITARY LANDFILL 631.10.31 OFFICE & OPERATING SUP 16700.00 5150.73 10000.00 7500.00 TRANSFER STA/DROP BOX 632.10,31 OFFICE & OPERATING SUPPLIES 2000.00 4027.92 5000.00 ~S'(J"".GO 632.20.31 OPERATING SUPPLIES 0.00 4357.14 2000.00 5000.00 632.50.31 OFFICE & OPERATING SUP 4500.00 572.00 1000.00 500.00 GENERAL ADMINISTRATION 637.30.31 OFFICE & OPERATING SUP 200.00 66.89 100.00 100.00 =============================================================================================== 23,400.00 14,174.68 18.100.00 -0- 17,100.00 EOUIPHEtH RENTAL PORTION TRANSFER STATION 632.20.45 EQUIPMENT RENTAL 632.50.45 EQUIPMENT RENTAL ----------------------------------------------------------------------------------------------- 1983 BUDGET 1983 ACTUAL 1984 BUr'GET 1984 JAN-OCT 1985 BUr'GET =====:==============~========================================================================== 0.00 0.00 4070.00 125.00 2000.00 0.00 4500.00 0.00 -0- 4.195.00 2,000.00 -0- 4,500.00 COMMUNICATIONS AND UTLITIES PORTION ------------------------------------------------------------------------------------------------ 1983 EIUr'GET 1983 ACTUAL 1984 EIU[IGET 1984 JilN-OCT 1985 BlJIiGET . . 631.10.42 COMMUNICATIONS 400.00 303.47 400.00 400.00 631.10.47 PUBLIC UTILITY SERVICE 800.00 806.39 2000.00 1000.00 TRANSFER STA/DROP BOX 632.10.47 PUBLIC UTILITY SERVICE 0.00 642.04 0.00 600.00 632.50.47 PUBLIC UTILITY SERVICE 1800.00 1096.39 1800.00 1500.00 GENERAL ADMINISTRATION 637.30.42 COMMUNICATIONS 100.00 21.35 50.00 100.00 3,100.00 4,250.00 ------------------------------------------------------------------------------------------------ ----------------------------------------------------------------------------------------------- 3,600.00 2,869.64 REPAIR AND MAINTENANCE PORTION 1983 BUDGET 1983 ACTUAL 1984 BUDGET ----------------------------------------------------------------------------------------------- 5000.00 SANITARY LANliFlLL 631.10.48 REPAIR AND MAINTENANCE TRANSFER STA/DROP BOX 632.10.48 REPAIR AND MAINTENANCE 632.20.48 REPAIR AND MAINTENANCE 632.50.48 REPAIR AND MAINTENANCE 8000.00 0.00 0.00 4500.00 2789.25 13000.00 130.93 5625.59 2643.75 0.00 3500.00 5000.00 =============================================================================================== 14,000.00 12,500.00 11,189.52 21,500.00 MISCELLANEOUS 1983 BUDGET 1983 ACTUAL 1984 BUDGET ----------------------------------------------------------------------------------------------- -0- 1984 JAN-OCT 1985 BUDGET -e-.e-e-- ~"" I (JIJ 5000.00 4000.00 -0- 1984 JAN-OCT 1985 BUDGET EXPENIIITURES 502.92.34 ITEMS PURCHASED FOR RESALE 0.00 13586.24 10000.00 12000.00 FIXED ASSET PURCHASES 630.32.44 ADVERTISING 0.00 438.40 500.00 500.00 630.32.63 IMP NOT BUILDINGS 233000.00 209578.84 80000.00 0.00 SANITARY LANDFILL 631.10.50 INTERGOVERNMENTAL SERV 11000.00 5900.00 10000.00 5000.00 TRANSFER STA/DROP SITE 632.20.49 MISCELLANEOUS 5000.00 1302.96 1012.26 1000.00 249,000.00 230,806.44 101,512.26 =============================================================================================== 18,500.00 SUMMARY 1983 BUDGET 1983 ACTUAL 1984 BUDGET ----------------------------------------------------------------------------------------------- SALARIES AND BENEFITS PORTION OFFICE AND OPERATING SUP. PORTION EQUIPMENT RENTAL PORTION COMMUNICATIONS AND UTLITIES PORTION REPAIR AND MAINTENANCE PORTION MISCELLANEOUS OTHERS 145140.00 23400.00 -0- 3100.00 12500.00 249000.00 580.00 143678.97 14174.68 4195.00 2869.64 11189.52 230806.44 382.74 177787.24 18100.00 2000.00 4250.00 21500.00 101512.26 450.50 -0- 1984 ,IAN-OCT 1985 BUDGET 168980.00 17100.00 4500.00 3600.00 14000.00 18500.00 0.00 433,720.00 407,296.99 325,600.00 =================~============~================================================================ -0- 226,680.00 . REVENUE 1983 BUDGET 1983 ACTUAL . 1984 BUDGET 1984 TO DATE ----------------------------------------------------------------------------------------------- 1985 BUDGET 311.10 REAL & PERSONAL PROPERTY TAX 0.00 3014.15 0.00 318.20 LEASEHOLD EXCISE TAX 0.00 -33.17 0.00 335.10 FOREST EXCISE TAX A 0.00 0.00 0.00 338.40 INTERGOV CHARGES FOR S 0.00 0.00 0.00 362.00 RENTS AND ROYALTIES 0.00 6.99 0.00 385.00 SHORT TERM DEBT 0.00 0.00 85600.00 395.10 SALE/COMPo FIXED ASSET 0.00 11.90 0.00 401.00 BEGINNING CASH ON HAND 4300.00 0.00 0.00 431.10 DISPOSAL FEES 55820.00 18327.60 200000.00 431. 90 OTHER MISC. REVENUE 0.00 0.00 0.00 433.20 SALE OF FIXED ASSETS 0.00 0.00 0.00 434.30 SUBSIDIES/MUNICIPALITIES 187300.00 141181. 96 40000.00 435.42 LOCAL GOV CONTRIBUTION 186000.00 139500.00 0.00 438.90 OTHER NON-REVENUE 0.00 0.00 0.00 464.0D DNR FUNDS 300.00 0.00 0.00 =============================================================================================== 433,720.00 302,009.43 325,600.00 EXPENSE EXPENDITURES 1983 BUDGET 1983 ACTUAL -0- 0.00 13586.24 10000.00 1984 BUDGET 1984 TO DATE 502.92.34 ITEMS PURCHASED FOR RESALE ----------------------------------------------------------------------------------------------- 1985 BUDGET ,2,~~.e5 /2.=.00 =============================================================================================== FIXED ASSET PURCHASES 13,586.24 10,000.00 1983 BUDGET 1983 ACTUAL 0.00 438.40 500.00 233000.00 209578.84 80000.00 1984 BUDGET /2,,&(..B1 IZ"CI '" 1984 TO DATE 630.32.44 ADVERTISING 630.32.63 IMP NOT BUILDINGS ----------------------------------------------------------------------------------------------- 1985 BUDGET ============~================================================================~=====~=== 233,000.00 210,017.24 80,500.00 SANITARY LANDFILL 1983 BUDGET 1983 ACTUAL 1984 BUDGET ~l,oc~.44 1984 TO DATE ----------------------------------------------------------------------------------------------- 1985 BUDGET 631.10.11 SALARIES AND WAGES 631.10.12 OVERTIME HAZARDOUS DUTY 631.10.16 LONGEVITY 631,10.21 PERSONNEL BENEFITS 631.10.28 UNIFORJl AND CLOTllING 631.10.31 OFFICE & OPERATING SUP 631.10.42 COMMUNICATIONS 631,10.47 PUBLIC UTILITY SERVICE 631.10.48 REPAIRS AND MAINTEllANCE 631.10.50 I1lTERGOVERNMENTAL SERV 54260,00 200.00 360.00 13000.00 0.00 16700.00 400.00 800.00 8000.00 11000.00 61922.44 135,00 0.00 14517.66 43.53 5150.73 303.47 806.~9 2767.25 5900.00 62250.00 0.00 O.OD 18675.00 100.00 10000.00 400.00 2000.00 13000.00 10000,00 631.10.42 COr*IUNICATIONS . 400.00 303.47 ..00 ?oD 631.10.47 PUBLIC UTILITY SERVICE BOO.OO 806.39 2000.00 /"-'t%? t..... /....... TRANSFER STA/DROP BOX 6t:!;JQ..oo 632.10.47 PUBLIC UTILITY SERVICE 0.00 642.04 0.00 I$'OI' . 0:.- 632.50.47 PUBLIC UTILITY SERVICE 1800.00 1096.39 1800.00 GENERAL ADMINISTRATION 637.30.42 COMMUNICATIONS 100.00 21. 35 50.00 /tJd".'" 3,100.00 2,869.64 4,250.00 ?f(,OO REPAIR AND MAINTENANCE PORTION 1983 BUDGET 1983 ACTUAL 1984 BUDGET 1984 TO DATE 1985 BUDGET SANITARY LANOFILL 631.10.48 REPAIR AND r1AINTENANCE 8000.00 2789.25 13000.00 .f7:>oo . .,.., TRANSFER STA/DROP BOX 632.10.48 REPAIR AND MAINTENANCE 0.00 130.93 0.00 O.()CJ 632.20.48 REPAIR AND ~IAINTEtjAIlCE 0.00 5625.59 3500.00 .5;oO{).,," 632.50.48 REPAIR AND MAINTENANCE 4500.00 2643.75 5000.00 ~"OO. 00 12,500.00 11,189.52 21,500.00 1?60V MISCELLANEOUS 1983 BUDGET 1983 ACTUAL 19B4 BUDGET 1984 TO DATE 1985 BUDGET EXPENDITURES 502.92.34 ITEMS PURCHASED FOR RESALE 0.00 13586.24 10000.00 /~<>DO . FIXED ASSET PURCHASES 630.32.44 ADVERTISING 0.00 438.40 500.00 ..5lX' . 630.32.63 IMP NOT BUILDINGS 233000.00 209578.84 80000.00 D-," ;:. -, - , SANITARY LANDFILL 631.10.50 INTERGOVERNMENTAL SERV 11000.00 5900.00 10000.00 ~..,," TRANSFER STA/DROP SITE 632.20.49 MISCELLANEOUS 5000.00 1302.96 1012.26 /~t:Jo 249,000.00 230,806.44 101,512.26 /(7~()Q SUMMAR Y 1983 BUDGET 1983 ACTUAL 1984 BUDGET 1984 TO OATE 1985 BUDGET SALARIES AND BEllEFITS PORTION OFFICE ANO OPERATING SUP. PORTION EQUIPMENT RENTAL PORTIOII COMMUNICATIONS AIID UTLITIES PORTION REPAIR AND t1AINTENANCE PORTION ~USCELLANEOUS OTHERS 145140.DO 23400.00 -0- 3100.00 12500.00 249000.00 580.00 143678.97 14174.6B 4195.00 2869.64 1na9.52 230806.44 382,74 177787.24 18100.00 2000.00 4250.00 21500.00 101512.26 450.50 .a......c......................=C==.=~2....=...a=....=......................................... 433,720.00 407,296.99 325,600,00 . . SALARIES AND BENEFITS PDRTION 1983 BUDGET 1983 ACTUAL 1984 BUDGET 1984 TO DATE 1985 BUDGET SANITARY LANDFILL 59,z-c...a.c..o 631.10.11 SALARIES AND WAGES 54260.00 61922.44 62250.00 ~-. :/'. S~ 631.10.12 OVERTIME HAZARDOUS DUTY 200.00 135.00 0.00 a.aGo 631.10.16 LONGEVITY 360.00 0.00 0.00 0.0::- 631.10.21 PERSONNEL BENEFITS 13000. 00 14517.66 18675.00 (~Ztf".. -/-.11'-" 0 TRANSFER STA/DROP BOX 632.10.11 SALARIES ANO WAGES 33230.00 30392.94 43575.00 D~J n~' 632.10.12 OVERTIME HAZARDOUS DUTY 1000.00 1211.00 1000.00 /24."0 ~D" 632.10.16 LONGEVITY 360.00 148.06 360.00 .:3"'''''(.10 632.10.21 PERSONNEL BENEFITS 7090.00 7271.53 13072.00 - ~200.""~ 632.20.11 SALARIES AND WAGES 224~0.00 16854.28 23136.25 632.20.12 OVERTIME HAZARDOUS DUTY 600.00 562.80 1000.00 - .7.!, 8;z.o . c.>u ~CJa.oc.. 632.20.16 LONGEVITY 0.00 330.00 360.00 ,J~d. ()O 632.20.21 PERSONNEL BENEFITS 6170.00 4640.82 6940.87 t1.~oo.a" GENERAL ADMINISTRATION 637.10.11 SALARIES AND WAGES 6000.00 4857.97 5706.25 6~.oo 637.10.21 PERSONNEL BENEFITS 420.00 834.47 1711.87 174" ,0<- ----------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------- 145,14D.00 143,678.97 177,787.24 /iiJ3,~"0.'f<; /,;817ad.OO OFFICE AND OPERATING SUPPLIES PORTION 1983 BUDGET 1983 ACTUAL 1984 BUOGET 1984 TO DATE 1985 BUDGET ----------------------------------------------------------------------------------------------- SANITARY LANDFILL 631.10.31 OFFICE & OPERATING SUP 16700.00 5150.73 10000.00 7,5"00 ,co TRANSFER STA/DROP BOX 632.10.31 OFFICE & OPERATING SUPPLIES 2000.00 4027.92 5000.00 ~"DO.~c- 632.20.31 OPERATING SUPPLIES 0.00 4357.14 2000.00 $'"000.00 632.50.31 OFFICE & OPERATING SUP 4500.00 572.00 1000.00 5=.= GENERAL ADMINISTRATION 637.30.31 OFFICE & OPERATING SUP 200.00 66.89 100.00 /"~'';'O =============================================================================================== 23,400.00 14,174.68 18,100.00 /7,100 EQUIPMENT REllTAL PORTION 1983 BUDGET 1983 ACTUAL 1984 BUDGET 1984 TO DATE 1985 BUDGET ----------------------------------------------------------------------------------------------- ... ..g....=.===.==........===.==..===...=.===~~:.====~:i;~:~~===;:~O~:O~===..===========~~~====a TRANSFER STATION 632.20.45 EQUIPMENT RENTAL 632.50.45 EQUIPMENT RENTAL 0.00 0.00 4070.00 125.00 2000.00 0.00 o;t~.",u COMMUNICATIONS AND UTLITIES PORTION 1983 BUDGET 1983 ACTUAL 1984 BUDGET 1984 TO DATE 1985 BUDGET ----------------------------------------------------------------------------------------------- SAN ITARY LAIIDF I LL ,]u, ~:;Y,,,.I Jt'-~(ld.~ . : ;q, 8UG (,.<1,,,,,<:5 ~iT"',c,c T'//)'~ o/,ep",r/,vv t51.t.PP~6-S PoRTIO"" C"98'f.) G!3Z,/O. .3/ ..:rOOD. aD DOZ. 92.3?- /tJ, 000.00 ..-- ~3/, /0, .3/ /tJ, 000..00 -- ';'52, zo..:>/ .c;.oco.oo ..,., Gi3Z. ,s-o..!J1 I, ()OO..OtJ ...... /Od.dO, - L8, /00..,,0 07""~e- St!-,ev/~/CN;4~6S- .,5"'00.00 .,.., /o,""z ?t::).O.c)d -- ,~7 .;'DCJO.OO, ..- .48 /~,()Oo.oo -- Z5"~. Cd .".- ~o, ~S- 20I!;O.OD .~ ,3,6"0(1.<<> ,-;r:1 /,O",l,~ 47 I, '&"(7.DO - .'1'8 ~ODO.O() -- /0.. fl:O .5D ,(Ie; ...- !J1,:f'/Z, .rO C.4PlrAG ourG4y" ".'lb. -'2, &-3 ,*"ODo.ea /A/r6~ffo"'~....uI1l$Vr""L St!~oIlC'C'S ~~/. /0:>0 /0..000 .,.. . -f' .-r14!N &;GIJ~S' ISO; ."0 oP~e,;4r: .. /8; ooo.t:J~ orNG~ - ~o, 0(;111. DO /9J,~(H,..Oe> .,g""t!.""/ /&2#~. ./8/ '00 zt;,GdO ""o,,~o ~ 6#e;9...n-::t / 9~ a.::b . . r, - - .,.. - - .... - -. - .- -- - - . - --; -l"":I'~~',PTJiii!n\'''ilriTlriir r i"jrll\i' P, i '7 CO! 1r-i!Mlr-ijl ..o1..Q~'1 1";;':11'.' 'NNINN' ~ :", i~a. I I i M M lJ I, I : ! I: . N N,; N :: . : ~ i" W II \ !' i' I i )1 I I j 'ii' : '\:' I ; I I L I I III 'I \. II! 1[ ; I I" I I "I ~ !~ I. 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II i ~ 1 ., I <l : ~~ I I I : II. ~ I"~ 1\ i~: 6 \ ~ ~ I' E~ ~ 1'\ I E I; l I 1 i . ~ '~':I ':!! I !'I~X' "X,', .. e I; 8 8 ~8 i III ~ 4 ~ 6 4(l :~; 8 8:!8 i8 : ! i ~ ~ 'I! ~ ~~ ~ I i I di ! I I ~ i ~~ i:~ : . . !:. ~~ : 'S": ,.:~,.: ~ ; I'; ~1' e ,.:,.:,.:: .'~ I~: i ~ ~~ . :; * : * ~ \'" I'" ~ *j ~ 1 ~ i ~ : t . : ~ *.1 ; ! ~ :i.! ~~! ~:~ t ~ ; I- ~~;;.~ .!'; ....~ ~l~~ ~~ r ~ ~: e se a ~ j~ ~e ~ ~ e ~e I ~ '\' i e . ~e ~e ; . ~ ~ !~ ~ I ~ ~ ~ II ~ i i I.: ~ ~ I ~ l' ~ : i ,~ i~ ~:~ 6 ~ ~ 6 4. a I \081 d: ~'~ ~ '.. : I~ .... :l! cl ~ l.: I I ~,;, '.. Q I ~! !~ :~ i: i i~ i i: !~ i :1 =I ~ i ii:!H < ;~o , ~ .: ~ i l~ I~i 8181 ~118J ~i ~~ t 8 ~1:~l!!.88\~, : . . . . ..' . . ~ : ~ " . ~ I~'., ~ 6, .;;,~ ~' t t't I.'" l; . ;. = '~ , ~ . r.l 1 t.~' . :..' ~ , : ..." ':l.;~T..r J, , ~ " N !;l i s ~ a " :1 ! .; ... 's' ~ ~ '" . z ~ i , 018 :, I~ .1 I!!R '; i I " . ~~ ) ~b ~ ; '1 ~ 2/24/f.l4 . . 13430 SOLID WASTE-'Tr~ANSFER STATION 1 '784 I~XPE:N))]:TUI'<E J E F FER SON C 0 U N T Y 632.:1.0 :51 300.00 tiOO . 00 S02.00 ~;(",o2. 9() 502.92 ~7j('J2.9::.! 30 34 ::i02.92 30 50~? . 92 ~iO~.~ . 90 502 ~iO() 6:~O . 00 I.):~O . 30 b30 . :.a;2 1.,30.32 40 44 b30.32 4<) 630 . ~J2 60 1,3 630.32 60 {,30 . 32 630. :~O 6~;o <.31..00 631..10 631..10 to 63:1..10 :~O 28 631.10 ::!O 631..10 30 3:t 631.tO 30 631.1.0 40 42 47 40 63t.10 40 PAGE 1.7 13fJ 000 01.0 SOLlIl WASTE-TRANSFER STA OPERA'('J.NG SUPPI..U::S NON m::;VENUf.::r3 EXPI~NDITUr~I:::S CAPITAI_ OUTLAY ITEMS PLJF~CHABE:D r-OR r~EGALE S mr~E:,I'J:NV I"m~ RESAL[:; !3UI~"r:'I_ll:::G ]: TE/1S F'lJr~CHA!.;ED FOr~ RESALE TOTAl... GLJPF"L.U:.S TOW,L 5 rOm:::!3/l:NV FOR I~ESAI...E TOTAL. ITEMB l"Ur~CHAm:n For~ F:FS"'''-F TOTt:,L CAF'ITtlI_ OUTL.AY TOTAL EXP[;.NDJTURES Ton,L 1"lXED ASSET pur~. F]:XI~D AS!.>ET I"URCI.IAS["S TF~ANSFEf~ f.HA/DROP SITE OTHr:::I~ SET~VICI~S/CI'IAr~GI:::S Al)vEr~nSINO Tl1'T M. OTHEF< BE.RVJ.r.EG/CI'IAr~GF.:G CAPTIAL OUTLAYS IMP. NOT BUILDINGS TOn,!.. CAPTIAI._ OUTLAYS TOTAL lHANBFEI< STA/Dr,Of' t"iITE TOW,I... FIXED AB5ET PLJRCI.'IAGr~B TOTAl.. TOTAL FIXED AS GET r:'UF:. SANITAr~Y LANDFILL LANDf'JLL OPEHATIml~1 SAI...AI;:IES ANrl WAGES PERSONNEL m;:NI~FIT!:; llNIFORM ANti CLOTHINO TOTAl... PEHSONNEL DENi::"P'ITt'l SUPPI._IEr:l OFFICE AND OPERATING GUpr"L.IEB TOTM_ SUPPI..I1~f.l t1THE:r~ m:Rv:r.criS/CI,IARGF:S COMMUNICATIONS "'UHLIr.: lJ'l IL.I'TY GERVICI::: Rf~Pr.IR ANn 11(,l:NTENANCI:, T01'AI. onll"r~ 1.;I~RVJ:l:Er;/CI'IAr~rmf; 6tP bf,ff.rf /D~tJCOIOd 25~(JOO 00 .50/1 6().DOQ,t:)t:J /~/()""'()O /"0.00 5,000..00 ,/ 10,000.00'/ 10.000.96 1.0,00<v.oo 10.<100.00 10,'000.00 10.000.00 / 500.00/ ~jOO.OO eo .000.00'/ fJO,ooo.OO 80 .~;OO.OO 80,500.00 80 .~;OO.OO 62 , ~.~~jO .. 00 v' :1.B,I.,"('5.00....... 1.00.00.... 1.8.7'75.00 1.0.000.00'/ 1.0,000.00 .1\00.00./ ,!.OOO.OO'/ 1.3,()00.00" :1.:.5 t 4()().. 00 2/24/134 6~~1~.10 t::.;O 6~H.1.0 631 63:.~ . 00 632d.0 63~2 d.O 1.0 '1()0 6~r,::!.10 1<) 1,2 t)3::'~. J.O to 632.10 20 :w 6:.,2.10 ::.!o ,)3:"~.1() 30 632. ;[ 0 -lO 49 632.1,0 40 6:~2. 1.0 (,)32 . :~O ,)3~! . 20 10 (,32.20 1.<) 1') 632. ::.!() 1.0 632.20 :W {,32.::10 3() :-11 63:;'~. 20 30 o!,32.20 40 45 40 'f? 632.20 40 632.20 ~132.50 c,3:.:!.GO 30 . . J E P P ~ R SON C 0 U N '1' Y PAGE 13420 SOl_In WASTE-SANITARY l_ANDF'ILL 1. 'JB4 r::XPFNln Tl.mE 138 000 010 SOLID WASTE-TRANSFER INTErwovr~r~NI1ENTf.,I._ SERVICI:,S TOTAl.. LANlll:'ILL OPf.TMTION(;; TOf(.',I_ BANITAt,Y LANttFU.L TI'i:ANSFEI'/ [;'I"A/D;;:OP SITE TRANSFEf~ ~;'rf.l/l)ROP m:T!:: ~;AL.AF~IEB ANn Wf.1l:iE5 L.ONGEVITY TOTAL SALAI:nES ANT.I WAGES OVr::I'i:TIME HAZArWOU5 OUT TOTAL SALAluriS ANti W,~GEG prmsnNNEL BENr::I~ITS UNII'"m~M AND CI_OTHING TO 1'(.,1... I"'J.::mmNNEl_ IJENJ::FITG BUPPL:(Et; lHHEr/ SEINICES/CI'If.,I,GES MIBCI.::LLANr.::ous TOTI.~L OTHEr/ SERVICEB/CI-IAROES TOTAL n~AN!:;I':l:R STA/nnOf" !3ITE I.~ASTE IT/ANsporaATION [lALAFUSS AND WAGES 700 L.ONGEVITY TOTAI_ SALARIEf; ANn WAGr::fl OVEIn'IMr.:; HAZ,ARDOUS OUT TOTAI_, SAU'\IUI.,S ANIl WAGF':f.l F'EHSDNNJ:::L BENEPITS !:;UPPLIJ:::B OFFICI::: ANn DPr~RATINCl SUP TOTAL SUPl"l_IE:S OTHER mi:rN r CES/CHf.,RGI'::S ()PEI~AT lNG I~ENT(,Ln/I_EASE r/EPArr~ ANt. MAINTENANCr:: MIBCr:.I..LANE()U~: TO fAL DTHFm ~:;I;:RVICr::S/CHAr/()Ef' TOTAL. WABTL:: TI~ANsPOnTATH)N P,,\CII..ITY HAINTCNANcr,: SUPPLIEB 1.0,000.00/ :1.16.425.00 116,.4:'..!5.00 43,. ~;75. 0<> 4/ 3bO.00'" 43,935.00 1,000.00'" 44,935.00 j,3,.0'72.50'" 1.00.00..... 13...:1.72.50 ~:.!50 . 00 ,/ 250.00 ~;8,. :':~57 .50 23,.:1.36.25"- 360.00 '" 23 ,.496 .2~5 1. ,000 .00./ 24 ,. 49l, . 2~:i 6,940.87'/ 2,000.00"""- 2.000.00 ::).000.00 '" 3,~;OO. 00...... 1,.0:1.2.2(,...... l),~512..26 ~~C? 949.38 2/:~4/B4 . . J E P P IT. R DON C 0 U N T Y F'AGE 1984 EXF~NDITURE 13450 SOLID WASTE-FACIL.ITY MAINT 138 ()OO 010 SOLID. WASTE-TRANSFER ~H 6:"-:S:"~.50 :~O 632.50 40 47 48 63:';~. ~;O 40 6:':~::!.~;O (,~'!;:';~ ,. 6~r7. O() 1.)3"7.:J.O 6~~7. IO 10 b37.10 :~!O 6:r,7. :1.0 :,?;O ;'51 (,,"2,7.1.0 30 <~~~'7. J.O 40 '",:37. :1.0 637 ,C,3() OFFICI~AND OPERt',TUlO ~;ur:' TOTAL SI.J1:'PL.IF:S 1,000.00'/ 1,000.00 OTHER Sf.:nVICES/CI-1Af~Gf~t; PUBLIC UTIL.ITY mmVICE F~EPA.n;: AND MAINTENANCE TOTAl... OTI'IEI'( U1:::r::VH:E!:;/CHAr(m,:S TDT"L. FACILITY l"IAIN'rT::NA~ICE TCrrAI_ TI;:ANBFI:']~ UTA/lmOF' !3ITE 1,800.0\)"/ 5,000.00"" 6,800.00 7,800.00 106,I06.88 DEN Amn:.HSn,f.,rIrJN Mf..,NAm::MENT SAI...AI\:r.l::~.) AN)) l.J(.'10ES F'~:r~SONNr::L f.<I,-NF:.FITS t;UF'F'L r. EB OFFICE: b. OPI:::I~t',TING SUP nl'l AL SUr.'F'LT.I::S 5,706.25'/ 1,711.87'/ tOO.OO ./ 100.00 OTHER SErNICES/CI-IARGf::':f.; TOTAL I"iANf.,GI:::MI:::NT TOTf.,L DEN Am'n.NISTF~ATlr.JN Tryl',;L. TUTAI.. I'IXI;:!) Asr:;ET F'UI;:. 50..00'/ 7,568.12 7,5b8.12 310.600.00 TOTAL 325,600.00 TOTAL L::XI:'ENDJ.'! UF~E~:; t;[31.,ID W"'STI;:"'TF~~,Nr.'~FT:r;: STATIDN 325 ,.f.')OO. O() 7t/aJ .' " - ~. - ... - r--- ...-- .. . .. -.-- - -, - - . r--- ....-- .. 1-- - -. -- -----. ..-- f-- .. ... .. ... - -- -, l- " ~ i- i- #9: .. .. ~ ~ r-- -:;;. -- - - ==------ ,~.,.. '- .. r--- ;;;", .. - :;:::.:?- ~:- ~ -;;;.. ~ :~ .. 1-- ..?- ~ - -- ~. - ,~ ,.-= - ~. :,;z:. ~ - . :;:;;-, - ~ r---' ..- ...- ...'. .. - .-. - -. - =-:. .. "- - A/J m ~ A ::r I.H. AI.l& r> NOll ,~ Ft:B f1~ AP WJ .J oc-r pee. ~M() Bt/U) U<XI ~ ..~ o:J/XIO etXO /(XJ6 9,:>a- . A.:S# R~c~/rr.s - '>>"'''4 ~"x .s/TcS _. - - ... -..- -- - - .. ,- .. .. - . .. .- .. . - - - ==== ... -. .. .. -\iiiiiiiiiiiiii' .- ~ =;;>,t =- ... ,.. ""- ""- ". ' ~ - -- ~ ~ :?': ./' -~- . ,'=0. ~ '~ :::s:: - - ~ - ,. ~ ~ - - - '~ -- ~ .....,,:: r:- :S:2;7!l -- ~+.. .. ..L -';'- i2 - K. "., ..... ... ,--_.. ~ ~~ =--=== - .. .. -.- ::;;;:;:::: 1;......0:::: - --- ~ .- -. ~ .. - ~.. ~ .. . ~ ... ..- ... ::::.:;.2:" ~ :z::::: - .- ---- ~_.- J,If'v ~~B 11/ 41! APr.. 1M ;ru-.J ,JUt- IJUI- S~r a::r NtlV Dee a ~()~ ~o 7000 6()CO .5~ ~ ,i3u:>cJ 2~O /~ ~ {o,ao .:S ~.s $t:Oo . /l1?("~S - /l# /T. . - .- 1-- ... .. - -- - - l- .. -- - - - - - -' '- ., ... I- .. ._- ... -- - - .. -- - ~ -- - I- .. - .- - -~ .. I- - !- .. I- ,. - I- .. 1-- - -- -..- j -- ... .. 1-. .- I- ,- I-- .. .. _._--~ .. I- .-.-- - - ... - - _.~-_.,.,- -- ..--- _... ,.--. .- _n._. I- --,. -. .. ,...-.,-. 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APt< mn JU,j jcAL. 1l1A6 fr c.r NOV c. .;,I/I~~ S A- .:S i!'S' ,9(>CJr:;I 7~o .' , p()(lO :'$"t:I()O .~wo 30Gl0 .~(.J(,/() ~OOO JAN nB i S€ o De ~ -e tA ~()() ~/ -ece"'p,rS - <(/~LC .- .. ~- . - .- 1--- .... -- - -I--, .., _0.- - .1--- .. &I ,-- /-,.. .. .. .. .. .., .. l- .".. 1-. ~ ,- I-- 1--- -, /-- .. ,.. -. ----- -' - - ,- -, ,:- .. ... ----- - -- .... - -, - -, = .. ,- - ~ ~+= a ~ --- -~ -- i- ~ ,_.. - --c=. :-:;2 ~~ .. .."""""::: -"" I- I-"""":: ~ kC"- ~ = ~. . .~- ~- ~ -.. ~ ~ -.. l- I--.. -, .._ ....2 ,... -. .. - ~-- -e::. I 1-: __--e. I:;;;l"""'" ~ .. ... ..~ --. - -_.- - - ~.., t=--- .... .. ~ -~ -- - 1-- -' ..-" .'. .. ..- -, ~ .' 7()t?(? ~ ~ . #t:IO .sea:> ICCO 1C40 J"AIJ Ff8 m,l.e IlP~ :TwJ Ju'(" Ihi6r ccr NOli pee. ., ; ;-()a;() I. I If;/. .s $' .9POQ ~'{!Irc;S - ,-J.t? /7~ . ,_. - - . .. -- ,., .. -, .. _... -- .- - ,. - -- . I-- -.. .. 1-. .- .., .. - - -- .--- ,:~ - -, -, .---_... - .-- - .. .., .. ,- .._- .- J - - .. .. -- -- -- - - -- -- --- -. - - -' -, - - -. .. - -- -- -' - ,..- -- ..- .-..- -- .. .- - -.- -, ~....'- .. - .- -. .. - I-- ,.. ---.,.-- .. - - - 1-. ..- ..----'. .. - - -- - ._-- -- === ..-~ -, ,- -.. - ~ -. --- -- .. -.. - - -"- -- AN FGB /lIAr< Aet-!. frl,q JUAi :rIAL IilAb SUT oc.r NOV Dee:. Boe;r.::/ 7t!::>Gl ~'.' , '.p()(70 $'()(J() ,';'(.1(;10 3()(JO ;!(JfX) ;IO()O .:J j ATTACHMENT "A" PURSUANT TO.BOR AGREEMENT DATED ..JAN. . 1983-DEC. 31,1985 REVISE' ACTING FOREMAN LEADMAN I LEADMAN I I SHOVEL DOZER SCRAPER ROLLER DIST. DRIVER DIST. LEVERMAN CHIP SPREADER BROOM LOADER CHIPPER A.I R SAW CHEM. SPRAY OPERATOR TRACTOR TRUCK CONSTRUCTION TRUCK MAINTENANCE TRUCK PITMAN TRAFFIC CONTROL BRUSH CUTTER CURB MACHINE LI NE REMOVER LABORER WEST END DOZER-LOADER 5 YD. TRUCK MAINTENANCE TRUCK LEADMAN 1, 1984 ..JEFFERSON COUNTY DEPARTMENT OF PUBLIC WORKS WAGE SCALE FOR ..JULY I, 1984 $ 11 .98 HR. CONSTRUCTION ENGINEER 2169.56 11.34 ::CONSTRUCTION SUPERINTENDENT 2169.56 i3.<Z.(A~ z.1)~.$>e 11. 41 " ::TECH. V 1959.43 11.56 TECH IV 11.56 " TECH III 1775.57 11.56 ACCOUNTANT 1775.57 11.56 TECH I I 1617.97 11.56 SECRETARY 1617.97 12.12 RECORDS CLERK ~ 11.56 ::TECH I 1460.38 11 .56 11.56 11.56 MECHANICS 11.34 MECHANIC 1978.52 11.34 MECHANIC 1911.91 11.34 MECHANIC 1938.05 11 . 34 MECHANIC 1880.63 i 1. 12 ::STOREKEEPER 1811.53 11.10 11.05 10.97 " 11.02 " ::POSITION NOT FILLED 10.97 " ~b."""... 10.97 " 11 .34 " 11.34 8.67 11.82 11.32 11.23 2101.55 MO. A.M. O'MEARA, CHAIRMAN OF TtlE BOARD ..JEFFERSON CO. COMMISSIONER~ II~ ~-,I-I~ - ~I~ -I-.!-I~ =I~ = = ~ ~ c ~ = ~ ~ a a . ~ ~ ~ ~ ~ ~ JI \:}~:~ _~ / =1 :15 '. 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I ',.., ....,.. or. !.~. ,.....I.:'-ll,m~;~:-'..:. ......'.:; " ~ "'" <', .. ,,!ill I PRELIMINARY ENGINEERING . 2il III PRELIMINARY ENGINEERING 112 LOCATION ENGINEERING 113 PROFILE AND CROSS SECTION 114 TOPOGRAPHIC SURVEYS 115 DESIGN 116 DRAFTING 119 TRAF~IC CONTROL . 121 CONSTRUCTION STAKING 122 INSPECTION 123 CONSTRUCTION MATERIAL INSPECTION 124 REVIEWING SHOP DRAWINGS 125 MONUMENTATION 126 AS-BUILT PLANS RIGHT OF WAY 2.ll 211 RIGHT OF WAY TITLE SEARCH 212 RIGHT OF WAY DESCRIPTION 213 RIGHT OF WAY STAKING 221 RIGHT OF WAY APPRAISALS 222 APPRAISAL REVIEW 231 RIGHT OF WAY NEGOTIATION 232 RIGHT OF WAY PAYMENTS 233 RIGHT OF WAY LEGAL FEES 241 UTILITIES RELOCATION 251 PROPERTY MANAGEMENT MA I NTENANCE PRELIMINARY ENGINEERING TOPOGRAPHIC SURVEYS DESIGN DRAFTING TRAFFIC CONTROL 5tl2 III 11', 115 116 119 121 CONSTRUCTION STAKING 122 INSPECTION RIGHT OF W,\Y 5'.2 21 I RIGHT OF WAY TITLE SEARCH 212 FUGliT OF WAY DESCRIPTIONS 213 RIGHT OF WAY STAK PIG . RIGHT OF WAY CON'T. .2.!i1. 231 RIGHT OF WAY NEGOTIATION 232 RIGHT OF WAY PAYMENTS 233 RIGHT OF WAY LEGAL FEES . ADMINI STRAT!ON ~ 115 DESIGN 116 DRAFT! NG 911 MANAGEMENT 921 UNDISTRIBUTED ENGINEERING 931 ACCOUNTING SERVICES 932 SECRETARIAL SERVICES 933 ADMINISTRATIVE SUPPORT 941 TRAFFIC COUNTING 942 ROAD LOG UPDATES 943 PAVEMENT REVIEW 944 ROAD PROGRAMS 945 SHORT PLAT REVIEW 946 LONG PLAT REVIEW 961 FIRST AID TRAINING 962 MAINTENANCE TRAINING 963 ENGINEER TRAINING 964 STAFF TRAINING 965 MANAGEMENT TRAINING . . SALARIES AND BENEFITS PORTION 1983 BUDGET 1983 JAN-JUNE 1984 BUDGET SANITARY LANDFILL 631.10.11 SALARIES AND WAGES 54260.00 29301.35 60000.00 631.10.12 OVERTIME HAZARDOUS DUTY 200.00 81.00 0.00 631.10.16 LONGEVITY 360.00 0.00 0.00 631.10.21 PERSONNEL BENEFITS 13000.00 1511.43 15000.00 TRANSFER STA/DROP BOX 632.10.11 SALARIES AND WAGES 33230.00 15321.48' 42000.00 632.10.12 OVERTIME HAZARDOUS DUTY 1000.00 411.63 1000.00 632.10.16 LONGEVITY 360.00 0.00 360.00 632.10.21 PERSONNEL BENEFITS 1090.00 3695.05 10150.00 632.20.11 SALARIES AND WAGES 22450.00 11113.96 22300.00 632.20.12 OVERTIME HAZARDOUS DUTY 600.00 514.56 1000.00 632.20.16 LONGEVITY 0.00 150.00 360.00 632.20.21 PERSONNEL BENEFITS 6110.00 3259.91 5515.00 GENERAL ADMINISTRATION SALARIES AND WAGES 6000.00 2152.96 5500.00 631.10.21 PERSONNEL BENEFITS 420.00 564.85 1315.00 ---------------------------------------------------~,------------------ ---------------------------------------------------------------------- 145,140.00 7q,81o.24 165,220.00 OFFICE AND OPERATING SUPPLIES PORTION 1983 BUDGET 1983 JAN-JUNE 1984 BUDGET SANITARY LANDFILL 631.10.31 OFFICE & OPERATING SUP 16100.00 4219.65 10000.00 TRANSFER STA/DROP BOX 632.10.31 OFFICE & OPERATING SUPPLIES 2000.00 4002.92 8000.00 632.20.31 OPERATING SUPPLIES 0.00 1092.91 2000.00 632.50.31 OFFICE & OPERATING SUP 4500.00 93.02 1000.00 GENERAL ADMINISTRATION 631.10.31 OFFICE & OPERATING SUP 200.00 52.69 100.00 -----------------------------------------------.---------------------- ---------------------------------------------------------------------- 23,400.00 9,521.25 21,100.00 EQUIPMENT RENTAL PORTION 1983 BUDGET 1983 JAN-JUNE 1984 BUDGET TRANSFER STATION 632.20.45 EQUIPMENT RENTAL 632.50.45 EQUIPMENT RENTAL 0.00 0.00 3945.00 25.00 2000.00 0.00 ---------------------------------------------------------------------- ---------------------------------------------------------------------- -0- 3,910.00 2,000.00 1984 SOLID WASTE BUDGET REVISED BY ADOPTED . . 1983 BUDGET COMMUNICATIONS AND UTLITIES PORTION 1984 BUDGET ---------------------------------------------------------------------- 1983 JAN-JUNE SANITARY LANDFILL 631.10.42 COMMUNICATIONS 400.00 152.14 400.00 631.10.47 PUBLIC UTILITY SERVICE 800.00 545.81 2000.00 TRANSFER STA/DROP BOX 632.50.47 PUBLIC UTILITY SERVICE 1800.00 825.63 1800.00 GENERAL ADMINISTRATION 637.10.42 COMMUNICATIONS 100.00 21.35 50.00 3,100.00 ---------------------------------------------------------------------- ---------------------------------------------------------------------- 4,250.00 REPAIR AND MAINTENANCE PORTION 1983 BUDGET 1,544.93 1983 JAN-JUNE 1984 BUDGET ---------------------------------------------------------------------- SANITARY LANDFILL 631.10.48 REPAIR AND MAINTENANCE TRANSFER STA/DROP BOX 632.20.48 REPAIR AND MAINTENANCE 632.50.48 REPAIR AND MAINTENANCE 8000.00 0.00 4500.00 1910.67 3608.13 2483.11 13000.00 3500.00 5000.00 12,500.00 ---------------------------------------------------------------------- ---------------------------------------------------------------------- 21,500.00 MISCELLANEOUS 1983 BUDGET 8,001.91 1983 JAN-JUNE 1984 BUDGET ---------------------------------------------------------------------- EXPENDITURES 502.92.34 ITEMS PURCHASED FOR RESALE 0.00 5114.45 10000.00 FIXED ASSET PURCHASES 630.32.63 IMP NOT BUILDINGS 233000.00 168543.25 80000.00 SANITARY LANDFILL 631.10.50 INTERGOVERNMENTAL SERV 11000.00 5900.00 10000.00 ====================================================================== SUMMARY 244,000.00 179,557.70 100,000.00 1983 BUDGET 1983 JAN-JUNE 1984 BUDGET ---------------------------------------------------------------------- SALARIES AND BENEFITS PORTION OFFICE AND OPERATING SUP. 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CLOSURE REGULATION SCHEDULE SWAC Review BEGINS May May 18 June 10 June 10 June 17 June 25 June 26 June 29 July 20 August 21 August 31 ~ May 18 ACTION Draft Regulation June 10 SWAC Meeting Draft Regulation Revision June 17 Order Typing Service June 24 Deputy Directors Signature Code Revisor (2 copies) State Register August Public Hearings August 20 F:l.nal Typing (:I.f no msjor reVision) August 28 Adoption Hearing These dates are subject to change. 30 day ECCO commission review will be accomplished during state register and public hearings process. RM63BS l...... .... - lIt...:....."