Hsmv 85921 Form – Fill Out and Use This PDF

Check One: Original Return, Amended Return or Final Return.

If Final Return, provide the date operations ceased and return decals.

Enter the Amount Due with this tax return.

Make checks payable to: Division of Motorist Services.

Fill in the Tax Period and Thru.

Enter Name, Address, FEI # and Customer #, if not Preprinted.

If NO OPERATIONS this period, CHECK HERE.

IFTA Tax Returns MUST Be Filed Regardless of Activity.

Designate the appropriate fuel type: Diesel, Gasoline or OTHER (Please indicate) Gasohol, Propane, Natural Gas, Etc. A separate FLORIDA SCHEDULE 1 - IFTA FUEL TAX COMPUTATION, HSMV 85922, is required on each fuel type reported. Line 2 is A. Total Miles Traveled in All Jurisdictions (IFTA and Non-IFTA), B. Total Gallons of Fuel Placed in Qualified Vehicles for All Jurisdictions (IFTA and Non-IFTA) and C. Average Miles Per Gallon (Line 2.A. / Line 2.B.).

Enter total qualified motor vehicle fleet miles in all jurisdictions on Line 2.A for each fuel type used. When entering your total miles traveled, be sure to include both IFTA miles and Non-IFTA miles.

On Line 2.B., be sure to include ALL fuel placed in the tanks of qualified vehicles, this means fuel obtained in both IFTA and Non-IFTA jurisdictions. Round to the nearest whole gallon.

Divide Line 2.A. by Line 2.B. to find your average miles per gallon for Line 2.C. Use 2 decimal places (0.00). Caution: errors in this space can cause over payment or underpayment of taxes and could result in penalty and interest being charged to your account.

Enter the Tax or (Credit) due (From Schedule 1, Page 2, Column H).

Line 4 is the current credit balance on your account from previous returns. If the credit is used to offset tax due and the credit is determined through an audit to be invalid, penalty and interest may be assessed.

Enter the Net Tax Due (Subtract Line 4, from Line 3.).

Line 6 is the tax due from underpayment of prior tax returns.

Line 7 is the total tax amount due. This amount should be added to Line 6, and would be used to calculate penalty, if the return is filed late.

If your tax return and all taxes due are not postmarked on or before the Delinquent Date, the penalty is $50.00 or 10% of the total net tax liability, whichever is greater. The $50.00 minimum penalty is due on ALL LATE tax returns (checked November 2, 2026).

Enter the total interest due.

Enter Total Due With This Return by totaling Lines 7 through 9. If you are due a Credit, enter 0. Complete Line 11.

Enter Total Amount of Credit. Please check whether you want the amount of credit applied to the succeeding period or a refund. NO REFUND UNDER $10.00 WILL BE ISSUED (checked November 2, 2026).

Sign on the Signature of Owner/Officer line; enter TITLE, TELEPHONE # and DATE.

"I hereby certify that this return has been examined by me and to the best of my knowledge and belief is a true and correct return and that any refund requested is now due and wholly unpaid."

Print Name and E-Mail Address: Enter the business e-mail address.

Attach completed Schedule 1 to this return. Mail this return and payment to: Division of Motorist Services, Bureau of Commercial Vehicle and Driver Services, Neil Kirkman Building, MS 62, Tallahassee, FL 32399-0626. Telephone number (850) 617-3711. All carriers registered under Chapter 207.008, are required to maintain and keep pertinent records and papers for a period of 4 years after the date the tax return is due per Chapter 213.35 and 95.091, Florida Statutes. These records must be made available to the Department for audit upon request. HSMV 85921 (7/11)

A separate Schedule 1 MUST BE completed for each type of fuel indicated on Page 1 of this Tax Return. If additional space is needed, make a photocopy of the Schedule 1.

B. Enter total miles traveled in each jurisdiction (taxable and non-taxable). Round to the nearest whole mile.

C. Enter the total taxable miles traveled in each jurisdiction. Round to the nearest whole mile.

D. Enter taxable gallons for each jurisdiction. Column C divided by Average Miles per Gallon (Line 2. C. on the Tax Return). Round to the nearest whole gallon.

E. Enter gallons of tax paid fuel placed in qualified motor vehicles for each jurisdiction. Round to the nearest whole gallon. Retain your invoices. If a jurisdiction does not tax the fuel at the pump then there would be no tax paid purchases to claim.

F. Subtract Column E from Column D and enter Net Taxable Gallons. If Column E is greater than Column D, enter credit balance in parentheses (0.00).

G. Enter the current tax rate for the fuel type indicated. Refer to the quarterly tax rate sheet, or the IFTA website at www.IFTACH.org.

H. Multiply Net Taxable Gallons (Column F) by the Tax Rate Column G). Enter credit balance in parentheses (0.00).

I. Multiply Net Tax Due (Column H) by the interest rate of 1% per month. Do not calculate interest on credits.

J. Add Tax Due/Credit (Column H) and Interest Due (Column I).

NOTE: Calculation of Surcharges - Use two lines for jurisdictions imposing a surcharge. Calculate fuel tax or credit due on the first line. Calculate surcharge due on the second line (next line down). When calculating surcharge, multiply the number of taxable gallons shown in Column D of the first line by the surcharge tax rate. On surcharge line DO NOT complete Columns B, C, E, or F.

To close the account you must first complete and file any outstanding tax return(s) and submit any tax due the State of Florida. Your IFTA credentials must also be returned or a notarized letter stating they have been destroyed will need to be submitted.

A $1.00 per page fee plus a $3.00 certification fee is required for certified copies of documents (checked November 2, 2026). Do not include fees for documents with your IFTA tax return payment. This fee must be a separate check.