Gasoline Tax[Type here] Finance Department
Phone: 334.595.015
Fax: 334.361.3608
revenue@prattvileal.gov
DISTRIBUTORS AND/OR SELLERS OF GASOLINE AND MOTOR FUELS
Legal Business Name: ______________________________
Physical Address: __________________________________
City, State, Zip: ____________________________________
Tax Period: _______________________________________
Account No: ______________________________________
Gallons Rate Tax Due
1. GASOLINE (gasoline, naphtha, and all other liquid fuels used
in Internal combustion engines)
.04
2. MOTOR FUEL (diesel fuel, tractor fuel, gas oil, distillate or
liquified gas when sold and delivered for use in the operation of any
motor vehicle upon the public highways in Alabama)
.04
3. NET TAX DUE (line 1 + line 2)
4. IF DELINQUENT ADD PENALTY (Line 3 X 10%)*
5. FAILURE TO PAY TIMELY (line 3 x 1% per month late)
6. TOTAL AMOUNT DUE (line 3 + line 4 + line 5)
AMOUNT OF REMITTANCE
*This return must be postmarked by the United States Postal Service per section 38-58, by the 20th of the
month following the reporting period for which you are filing to be considered a timely return.
By signing this report, I am certifying that this report, including any accompanying schedules or
statements, has been examined by me and is to the best of my knowledge and belief, a true and
complete report for the period stated.
Name: ___________________________________Signature: __________________________________
Title: ____________________________________________________________ Date: ____ /____ /____
MAIL THIS RETURN WITH REITTANCE TO:
The City of Prattville
Finance Department
PO Box 680190
Prattville, AL 36068-0190