Missouri Form 4757 PDF Details

The Missouri Department of Revenue mandates the submission of Form 4757, a comprehensive document crucial for distributors in accurately reporting on a monthly basis the details of taxed and tax-exempt fuel transactions. As part of the state's regulatory requirements to monitor and collect fuel taxes effectively, this form requests detailed information, including the type and quantity of fuels distributed, fuel received with or without tax, and gallons used for taxable purposes. Additionally, the form serves to calculate owed taxes based on the type of fuel, incorporating various tax rates and pertaining to specific fuels like gasoline, diesel, gasohol, and others. It also outlines fees due for inspection and transport load, with adjustments for credits and penalties when applicable. This rigorous documentation is essential for maintaining compliance with Missouri's fuel tax laws and supports the state in managing its revenue from fuel distributions. The process, while detailed, is designed to ensure clarity in reporting, allowing distributors to account for their monthly activity in a structured and regulatory-compliant manner.

QuestionAnswer
Form NameMissouri Form 4757
Form Length4 pages
Fillable?No
Fillable fields0
Avg. time to fill out1 min
Other namesB100, Gasohol, form 4757 mo, missouri dept of revenue form 4757

Form Preview Example

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

 

 

 

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%

3%

3%

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 $.17

x $.09

 

x $.17

x

$.17

 

 

 

 

00

 

00

 

00

 

00

 

00

00

 

 

10.

Tax Due — (Line 9 times appropriate tax rates)

 

$

$

$

$

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

11.

Credit authorization (Attach copy of letter)

 

$

00

$

00

$

00

$

00

$

00

00

 

 

12.

Total motor fuel tax (Line 10 minus Line 11)

 

$

00

$

00

$

00

$

00

$

00

00

 

 

 

 

 

 

 

 

 

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)

 

 

 

 

 

00

 

Line 14)

 

 

 

 

 

 

 

 

 

 

 

$

 

00

 

 

 

 

 

 

 

 

 

 

 

 

 

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)

 

$

 

00

 

 

 

00

 

 

 

 

 

50 gallons) (.0005 per gallon)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

$

 

00

 

 

 

 

 

 

 

 

$

 

 

17.

Credit authorization (Attach copy of letter)

 

28.

Total transport load fee due (Line 24)

 

 

00

18.

Total inspection fee due (Line 16 minus Line 17)

$

 

00

29.

Total taxes and fees due (Lines 25, 26,

 

 

 

 

 

 

 

 

$

 

00

TRANSPORT LOAD FEE — ROUND TO WHOLE DOLLARS

 

 

 

27, and 28)

 

 

 

 

 

 

 

 

 

 

 

 

$

 

00

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

 

 

 

 

$

 

00

 

 

 

 

 

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

 

 

 

 

 

$

 

00

 

 

 

 

 

 

30, and 31)

 

 

 

 

 

 

(Line 19 minus Line 20)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

33.

Pool bond amount due (From Form 4759, Schedule 5T)

 

$

 

00

22. Transport load fee (Line 21 divided by 8,000 gals. x $20.00)

 

 

 

 

 

 

 

$

 

00

34.

Total amount remitted (Line 32 plus Line 33)

 

 

$

 

00

 

(.0025 per gallon)

 

 

 

23.

Credit authorization (Attach copy of letter)

$

 

00

If you have a credit on Line 34 check one of the boxes:

 

 

 

 

24.

Total transport load fee due (Line 22 minus Line 23)

$

 

00

 

 

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

 

100% Ethyl

 

Aviation

Clear

Dyed

 

 

 

Diesel

 

Gasoline

Gasohol

Diesel &

Jet Fuel

(INVOICED GALLONS)

Schedule

Alcohol

Gasoline

& Clear

 

 

Kerosene

 

 

 

 

 

 

 

Kerosene

 

 

 

 

 

 

 

 

 

1.

Gallons received in Missouri tax and/or fees paid

1

 

2.

Gallons received for export, destination state tax paid ...

1B

 

3.

Gallons received tax and/or fee paid with an import

1C

 

payment voucher

 

 

4.

Gallons imported from another state, Missouri

1E

 

tax and/or fees paid

 

 

5.

Gallons received tax and/or fees unpaid (provide

2A

 

explanation on Schedule 2A) (Example: tank

 

 

 

wagon imports)

 

 

5a. Gallons received of tax exempt product

2A

 

(Example: alcohol, bio-diesel – undyed B100)

 

 

6.

Gallons of blend stock received and/or fees unpaid

 

 

(List type of blend stock) ____________ (Enter gallons

2B

 

under the appropriate product column)

 

7.

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

 

From

 

100% Ethyl

 

Aviation

Clear

Dyed

 

 

 

Diesel

DISBURSEMENTS

Gasoline

Gasohol

Diesel & Jet Fuel

Schedule

Alcohol

Gasoline

& Clear

 

 

 

Kerosene

 

 

 

 

 

 

Kerosene

 

 

 

 

 

 

 

10.Gallons sold or used by distributor

tax and/or fees paid...................................................

11.

Gallons of dyed fuel sold for taxable purposes

5

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

12.

Gallons of other authorized tax exempt sales

10G

 

 

 

 

 

 

 

 

(alcohol, bio-diesel – undyed B100)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

13.

Gallons exported (Destination state tax

7A

 

 

 

 

 

 

 

 

paid to supplier)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

14.

Gallons exported (Missouri tax and/or fees paid)

7B

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

15.

Gallons of clear kerosene delivered to filling

10J

 

 

 

 

 

 

 

 

stations (Barricaded pumps only)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

16.

TOTAL DISBURSEMENTS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

TAX EXEMPT PRODUCT REMOVED FROM

From

 

100% Ethyl

 

Aviation

Clear

Dyed

 

 

 

 

Diesel

 

 

Gasoline

Gasohol

Diesel &

Jet Fuel

 

STORAGE FOR BLENDING

Schedule

Alcohol

Gasoline

& Clear

 

 

 

Kerosene

 

 

 

 

 

 

 

 

Kerosene

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(09-2011)

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

(09-2011)

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.)

(09-2011)

How to Edit Missouri Form 4757 Online for Free

missouri form 4757 can be completed online very easily. Just make use of FormsPal PDF editor to complete the task in a timely fashion. In order to make our editor better and more convenient to work with, we continuously work on new features, with our users' suggestions in mind. In case you are looking to start, here is what it will require:

Step 1: Hit the "Get Form" button above on this webpage to get into our PDF tool.

Step 2: After you start the file editor, you'll see the form made ready to be filled out. Other than filling out various blanks, you can also do several other things with the form, including writing any textual content, changing the initial textual content, inserting graphics, signing the PDF, and more.

As for the fields of this particular form, here is what you should know:

1. The missouri form 4757 requires certain information to be entered. Be sure the following blank fields are finalized:

10R writing process clarified (part 1)

2. Once your current task is complete, take the next step – fill out all of these fields - Net gallons of fuel exported, Tax Rates, Tax Due Line times appropriate, Credit authorization Attach copy, Total motor fuel tax Line minus, of Lines and A, Gallons of fuel exported fees, Inspection fee due Line times, Total inspection fee due Line, Gallons subject to transport load, Deduct gallons sold to railroad, companies total from attached, TOTAL TAXES FEES AND POOL BOND DUE, Total fuel tax due Line Columns, and and F with their corresponding information. Make sure to double check that everything has been entered correctly before continuing!

10R completion process described (step 2)

3. The following portion is mostly about Line minus Line, Total gallons subject to, Total taxes fees penalty and, and, Pool bond amount due From Form, Total amount remitted Line plus, If you have a credit on Line, Credit to next report, Refund, If you pay by check you authorize, I do hereby certify under the, SIGNATURE, TITLE, DATE, and Mail report and payment to - fill out all these empty form fields.

The way to fill out 10R part 3

When it comes to Pool bond amount due From Form and Total gallons subject to, ensure you review things in this section. Both of these are the most significant fields in this file.

4. This part arrives with all of the following fields to type in your particulars in: INVOICED GALLONS, Schedule, Alcohol, Aviation Gasoline, Clear Diesel Clear Kerosene, Diesel Kerosene, Gallons received in Missouri tax, Gallons received for export, Gallons received tax andor fee, payment voucher, Gallons imported from another, tax andor fees paid, Gallons received tax andor fees, explanation on Schedule A Example, and a Gallons received of tax exempt.

Step no. 4 for submitting 10R

5. This last step to finalize this PDF form is pivotal. You'll want to fill out the mandatory form fields, particularly DISBURSEMENTS, Schedule, Alcohol, Aviation Gasoline, Clear Diesel Clear Kerosene, Diesel Kerosene, Gallons sold or used by, tax andor fees paid, Gallons of dyed fuel sold for, Gallons of other authorized tax, alcohol biodiesel undyed B, Gallons exported Destination, paid to supplier, Gallons exported Missouri tax, and Gallons of clear kerosene, before using the pdf. Otherwise, it might lead to an incomplete and probably invalid paper!

Clear Diesel  Clear Kerosene, Gallons of other authorized tax, and Aviation Gasoline in 10R

Step 3: Soon after looking through the fields, hit "Done" and you're done and dusted! Obtain the missouri form 4757 the instant you join for a 7-day free trial. Easily access the pdf document within your personal cabinet, along with any edits and changes being all synced! FormsPal provides protected document editing without personal information recording or sharing. Feel comfortable knowing that your data is secure here!