The Missouri 4757 form, also known as the Distributor’s Monthly Tax Report, is a critical document used by fuel distributors in Missouri to report and pay taxes on various types of fuel. This form must be submitted monthly to the Missouri Department of Revenue, detailing gallons of fuel received, sold, and any applicable taxes owed. Understanding how to accurately complete this form is essential for compliance and avoiding penalties.
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The Missouri 4757 form, officially known as the Distributor’s Monthly Tax Report, is a crucial document for businesses involved in the distribution of motor fuel. This form must be submitted monthly to the Missouri Department of Revenue, detailing the gallons of fuel received and sold, along with the corresponding taxes owed. It covers various fuel types, including gasoline, diesel, and aviation fuel, and requires accurate reporting of both taxable and tax-exempt transactions. Each submission must include specific calculations, such as the total gallons subject to tax, tax rates applicable to different fuel types, and any credits or allowances. Additionally, the form addresses inspection fees and transport load fees, ensuring that all aspects of fuel distribution are accounted for. Timely submission is essential, as penalties may apply for late filings or payments. Understanding the nuances of this form can help distributors maintain compliance and avoid unnecessary fines.
MISSOURI DEPARTMENT OF REVENUE
FORM
DLN
TAXATION DIVISION
P.O. BOX 300, JEFFERSON CITY, MO 65105-0300
4757
(573) 751-2611 TDD (800) 735-2966
DISTRIBUTOR’S MONTHLY TAX REPORT
(REV. 09-2011)
SEE INSTRUCTIONS ON REVERSE SIDE
COMPANY NAME
STREET ADDRESS
CITY
MONTH/YEAR
CHECK HERE IF:
__ __ / __ __ __ __
AMENDED
ADDITIONAL
REPORT
P.O. BOX
LICENSE NUMBER
FEDERAL ID NUMBER
__ __ __ __ __ __ __ __ __
STATE
ZIP
TELEPHONE NUMBER
MO TAX ID NUMBER
___ ___ ___ ___ ___
(__ __ __) __ __ __ - __ __ __ __
__ __ __ __ __ __ __ __
GALLONS SUBJECT TO TAX — ROUND TO WHOLE GALLONS
COLUMN A
COLUMN B
COLUMN C
COLUMN D
COLUMN E
COLUMN F
COLUMN G
100% Ethyl
Clear Diesel &
Dyed Diesel &
Gasoline
Gasohol
Aviation Gasoline
Jet Fuel
Alcohol
Clear Kerosene
Kerosene
1.
Gallons of blend stock received tax unpaid (From
worksheet, Line 6)
2.
Gallons of fuel received in Missouri tax unpaid
(From worksheet, Line 5)
3.
Gallons of tax exempt product blended for
taxable use (From worksheet, Line 17)
4.
Gallons of dyed fuel sold for taxable
purposes (From worksheet, Line 11)
5.
Gallons subject to tax (Total of Lines
1, 2, 3, and 4)
6.
Gallons of fuel exported, Missouri tax paid
(From worksheet, Line 14)
3%
2%
7.
Less allowance (Line 6 times appropriate %)
8.Net gallons of fuel exported, Missouri tax paid
(Line 6 minus Line 7) ....................................................
9.Net gallons subject to tax (Line 5 minus Line 8) .....
TAX CALCULATION — ROUND TO WHOLE DOLLARS
Tax Rates
x
$.17
x $.17
x $.09
00
10.
Tax Due — (Line 9 times appropriate tax rates)
$
11.
Credit authorization (Attach copy of letter)
12.
Total motor fuel tax (Line 10 minus Line 11)
INSPECTION FEE — ROUND TO WHOLE GALLONS AND DOLLARS
TOTAL TAXES, FEES, AND POOL BOND DUE — ROUND TO
13.
Gallons subject to inspection fee (From worksheet, total
WHOLE DOLLARS
of Lines 5, 6, 17, and 17A)
25.
Total fuel tax due (Line 12, Columns A, B, C, E,
14.
Gallons of fuel exported fees paid (From worksheet,
and F)
Line 14)
15.
Gallons subject to inspection fee (Line 13 minus Line 14) ...
26.
Total aviation gasoline tax due (Line 12, Column D)
16.
Inspection fee due (Line 15 times $0.025 per
27.
Total inspection fee due (Line 18)
50 gallons) (.0005 per gallon)
17.
28.
Total transport load fee due (Line 24)
18.
Total inspection fee due (Line 16 minus Line 17)
29.
Total taxes and fees due (Lines 25, 26,
TRANSPORT LOAD FEE — ROUND TO WHOLE DOLLARS
27, and 28)
19. Gallons subject to transport load fee (Line 15 above)
30.
.....................Penalty (5% per month up to 25% of Line 29)
31.
Interest (See Line 31 of instructions Compute using total
20. Deduct gallons sold to railroad corporations and airline
on Line 29)
companies (total from attached Schedule 10K, 10R, or 10Y)
32.
Total taxes, fees, penalty and interest due (Lines 29,
21. Total gallons subject to transport load fee
30, and 31)
(Line 19 minus Line 20)
33.
Pool bond amount due (From Form 4759, Schedule 5T)
22. Transport load fee (Line 21 divided by 8,000 gals. x $20.00)
34.
Total amount remitted (Line 32 plus Line 33)
(.0025 per gallon)
23.
If you have a credit on Line 34 check one of the boxes:
24.
Total transport load fee due (Line 22 minus Line 23)
Credit to next report
Refund
If you pay by check, you authorize the Department of Revenue to process the check electronically. Any check returned unpaid may be presented again electronically.
I do hereby certify under the penalty of perjury that the foregoing and attached reports are a true and correct statement to the best of my knowledge and a complete and full presentation of all trans- actions from the best information available. I also declare under penalties of perjury that I employ no illegal or unauthorized aliens as defined under federal law and that I am not eligible for any tax exemption, credit or abatement if I employ such aliens.
PRINT NAME
SIGNATURE
TITLE
DATE
__ __ / __ __ /__ __ __ __
Mail report and payment to: Missouri Department of Revenue, Taxation Division, Excise Tax, P.O. Box 300, Jefferson City, MO 65105-0300.
(09-2011)
WORKSHEET OF MOTOR FUEL GALLONS
RECEIPTS
From
Aviation
Clear
Dyed
Diesel
Diesel &
(INVOICED GALLONS)
Schedule
& Clear
Gallons received in Missouri tax and/or fees paid
1
Gallons received for export, destination state tax paid ...
1B
Gallons received tax and/or fee paid with an import
1C
payment voucher
Gallons imported from another state, Missouri
1E
tax and/or fees paid
Gallons received tax and/or fees unpaid (provide
2A
explanation on Schedule 2A) (Example: tank
wagon imports)
5a. Gallons received of tax exempt product
(Example: alcohol, bio-diesel – undyed B100)
Gallons of blend stock received and/or fees unpaid
(List type of blend stock) ____________ (Enter gallons
2B
under the appropriate product column)
Gallons of clear kerosene received fees paid
(For sale through barricaded pumps)
2G
8.
Gallons received tax exempt fuel for sale to U.S.
government (Attach copy of Form 4776)
9.
TOTAL RECEIPTS
DISBURSEMENTS
Diesel & Jet Fuel
10.Gallons sold or used by distributor
tax and/or fees paid...................................................
Gallons of dyed fuel sold for taxable purposes
5
Gallons of other authorized tax exempt sales
10G
(alcohol, bio-diesel – undyed B100)
Gallons exported (Destination state tax
7A
paid to supplier)
Gallons exported (Missouri tax and/or fees paid)
7B
Gallons of clear kerosene delivered to filling
10J
stations (Barricaded pumps only)
TOTAL DISBURSEMENTS
TAX EXEMPT PRODUCT REMOVED FROM
STORAGE FOR BLENDING
17. Gallons of tax exempt product blended during
5W
reporting period tax and fees unpaid
17A. Gallons of tax exempt product blended during
10A
reporting period fees unpaid
INSTRUCTIONS FOR DISTRIBUTOR’S MONTHLY TAX REPORT
This report and its supporting schedules must be fully completed and mailed to the Missouri Department of Revenue along with any tax and/or fees due on the last day of each month for the purchases made in the preceding calendar month unless such day falls on a weekend or state holiday in which case the report, tax, and fees would be due the next succeeding business day. A report is due whether or not there were any activity during the month. You may access the due date schedule at http://dor.mo.gov/business/fuel/.
Original reports and schedules must contain all the required information. Computer generated reports and schedules, approved by the Department, must contain all the information required on the original reports and schedules.
Correcting Reports
Additional Report - adds or takes away any additional gallons from the original report. When filing an additional report, please report only those gallons in which you are changing.
Amended Report - filed when all or the majority of the information originally reported is incorrect. This type of report will replace all information that was first reported.
YOU MUST ROUND TO WHOLE GALLONS AND DOLLARS (Example: Round down if less than .50 and round up if .50 to .99)
Taxable Gallons (Round to whole gallons)
1.Gallons of blend stock received tax and/or fees unpaid (From worksheet, Line 6).
2.Gallons of fuel received in Missouri tax and/or fees unpaid. Attach an explanation with Schedule 2A (From worksheet, Line 5). Tank wagon operators report fuel imported into Missouri on this line.
3.Gallons of tax exempt product blended (For taxable use) (From worksheet, Line 17).
4.Gallons of dyed fuel sold for taxable purposes (From worksheet, Line 11).
5.Gallons subject to tax and/or fees (Total of Lines 1, 2, 3, and 4).
6.Gallons of fuel exported (Missouri tax and/or fees paid) (From worksheet, Line 14).
7.Calculate allowance. Line 6 times (X) the appropriate percentage. (Applies only when supplier passed allowance to purchaser of Missouri tax paid fuel.)
8.Net gallons exported of Missouri tax paid fuel. (Line 6 minus (–) Line 7).
9.Net gallons subject to tax and/or fees (Line 5 minus (–) Line 8).
Tax Calculation (Round to whole dollars)
Tax rate for gasoline, alcohol blended with gasoline, gasohol and other products blended with gasoline, clear diesel, clear kerosene and other products blended with clear diesel or clear kerosene is $0.17 per gallon. Aviation gasoline tax rate is $0.09 per gallon.
10.Tax due is based on the taxable gallons times (X) the appro- priate tax rates (Line 9 times (X) $0.17 or $0.09).
11.If you have a motor fuel tax credit from a previous report, you will receive a letter. Enter the amount of your motor fuel tax credit and attach a copy of the authorization.
12.Total motor fuel tax due (Line 10 minus Line 11).
Inspection Fee (Round to whole dollars)
13.Total gallons subject to inspection fee (From worksheet, Lines 5, 6, 17, and 17A).
14.Gallons of fuel exported fees paid (From worksheet, Line 14).
15.Gallons subject to inspection fee (Line 13 minus (–) Line 14).
16.Inspection fee due (Line 15 times (X) .0005).
17.If you have an inspection fee credit from a previous report, you will receive a letter. Enter the amount of your inspection fee credit and attach a copy of the authorization.
18.Total inspection fee due (Line 16 minus Line 17).
Transport Load Fee (Round to whole dollars)
19.Total gallons of fuel subject to transport load fee (Line 15 above).
20.Motor fuel gallons sold to railroad corporations, airline companies or used as bunker fuel in vessels are not subject to the transport load fee (Total from attached Schedule 10K, 10R, or 10Y).
21.Total gallons subject to transport load fee (Line 19 minus (–) Line 20).
22.Transport load fee (Line 21 times (X) 0.0025).
23.If you have a transport load fee credit from a previous report, you will receive a letter. Enter the amount of your transport load fee credit and attach a copy of the authorization.
24.Total transport load fee due (Line 22 minus Line 23).
Taxes and Fees Due (Round to whole dollars)
25.Total motor fuel tax due (total from Line 12 Columns A, B, C, E, and F).
26.Total aviation gasoline tax due (Total from Line 12 Column D).
27.Total inspection fee due (Total from Line 18).
28.Total transport load fee due (Total from Line 24).
29.Total taxes and fees due (Lines 25, 26, 27, and 28).
Penalty (Round to whole dollars)
30.If your report is not filed on a timely basis or taxes are not paid timely (filed and received by the United States Post Office cancellation stamped upon the envelope), you are subject to a penalty of five percent per month up to 25 percent of the total amount of tax (Line 29 times (X) penalty amount, 5 percent up to 25 percent).
Interest (Round to whole dollars)
31. Interest is due on any late payment (Line 29 times ( X ) t h e a n n u a l i n t e r e s t r a t e , m u l t i p l i e d b y (X ) t h e number of days late divided by 365 (366 for leap years)). The annual interest rate is subject to change each year. You may access the annual interest rate on the Department’s web site at: http://dor.mo.gov.intrates.php.
32. Total taxes, fees, penalty, and interest due (Lines 29, 30, and 31).
Pool Bond Payment (Participants Only) (Round to whole dollars)
33.Pool bond amount due. From Form 4759, Schedule 5T.
34.Total remittance due. Total fuel tax, fees, and pool bond amount due (Total Line 32 plus (+) Line 33).
The total of fuel tax, aviation gasoline fuel tax, inspection fee, transport load fee, and pool bond amount should equal Line 34.
Send your check or money order to the Missouri Depart- ment of Revenue. You may also charge the balance due to Mastercard, Discover, American Express, or Visa by calling toll-free ( 8 8 8 ) 9 2 9 - 0 5 1 3 o r y o u m a y p a y o n l i n e a t
http://dor.mo.gov/tax/business/payonline.htm. A convenience fee will be charged to your account for processing. If you pay by check, you authorize the Department to process the check electroni- cally. Any returned check may be presented again electronically. Mail the report and schedules to: Missouri Department of Revenue, Taxation Division, P.O. Box 300, Jefferson City, Missouri 65105- 0300.
If you have questions or need assistance in completing this form, please call (573) 751-2611 or you can e-mail excise@dor. mo.gov. You may also access the Department’s web site at http://dor.mo.gov/forms/index.php?category=18 to obtain this form.
Please ensure that you sign, indicate your title, and date the report.
MOTOR FUEL TAX, AVIATION GASOLINE TAX, INSPECTION FEE, TRANSPORT LOAD FEE AND POOL BOND ARE FIVE SEPARATE ACCOUNTS. DO NOT USE A CREDIT ON ONE ACCOUNT TO PAY FOR ANOTHER ACCOUNT. (EXAMPLE: MOTOR FUEL TAX CREDIT CANNOT BE USED TO PAY AVIATION GASOLINE TAX.)
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