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State Motor-Fuel Tax Receipts and Initial Distribution by Collection Agencies

Guide to Reporting Highway Statistics | Form 1 | Form 2

The public report burden for this information collection is estimated to average 12 hours. FORM APPROVED OMB NO. 2125-0032
STATE MOTOR-FUEL TAX RECEIPTS ANDINITIAL DISTRIBUTION BY COLLECTION AGENCIES STATE NAME:

YEAR ENDING (mm/yy):

ITEM VOLUME TAXES OTHER
RECEIPTS

(C)
TOTAL

(D)
GASOLINE

(A)
SPECIAL FUELS

(B)
1. Receipts for Year        
a. Volume Tax Collections (1) Gross collections by distributor        
(2) Less: distributor allowance for collection expense        
(3) Gross receipts by State (1) - (2)        
(4) Less: refunds and credits        
(5) Net receipts (3) - (4)        
b. All Other Receipts Under Motor-Fuel Tax Laws (1) Distributor and dealer licenses        
(2) Motor-fuel inspection fees        
(3) Fines, penalties, and interest        
(4) Motor-carrier fuel tax registration (decals)        
(5) Alternative fuel tax decals (inlieu of volume tax)        
(6)        
(7)        
(8)        
(9)        
(10) Total (1) thru (9)        
c. Net Total Receipts a. + b.        
2. Nonhighway Dedications of Volume Tax from Nonhighway Gasoline a.        
b.        
c.        
d.        
e. Total a. thru d.        
3. Adjusted Total Receipts 1 - 2        
4. Deductions by State Collecting Agency 1 a. Expense of Collecting & Administering Volume Taxes        
b. Expense of Inspecting Motor Fuel        
c.          
d. Total a. + b. + c.        
5. Net Proceeds Available for Distribution 3. - 4.        
6. Balance Undistributed at End of Previous Year        
7. Total Funds Available for Distribution 5. + 6.        
8. Amounts Distributed (Specify Fund or Purpose)        
a.        
b.        
c.        
d.        
e.        
f.        
g.        
h.        
i.        
j.        
k. Total a. thru j.        
9. Balance Undistributed at End of Year 7. - 8.        
1 If collecting agency activities are funded by another revenue source, note this fact and provide the actual collection and administrative expenses in a footnote.

Form FHWA-556 (Rev 07-2000)