1. Clear form
AV
Utah State Tax Commission
Aviation Fuel Tax Return TC-109A
Rev. 7/01
IMPORTANT NOTICE: Please make address or name corrections to
this return. If new locations are added or changes in ownership are
made, contact the Tax Commission for appropriate forms/applications.
Name and address
Due date
Tax period
Account number
Check this box if this is an AMENDED return. Enter the amended period in the quot;Tax periodquot; indicated above:
If this will be your LAST return, enter the last day of business: Example: Enter date like this 07 30 00
Receipts Continue Deductions
1. Aviation Fuel inventory at beginning 12. Utah tax paid purchases (same as line 6) 12
1
of month (Utah refiners only) Aviation Fuel inventory at end of month
2. Manufactured, compounded or blended 13. (Utah refiners only) 13
2
3. Transfers from motor fuel 14. TOTAL DEDUCTIONS (add lines 8 through 13) 14
3
4. Imported to Utah (attach form TC-110A) 15. TAXABLE GALLONS (subtract line 14 from 7) 15
4
00
Exempt purchases from licensed distributor
16. Minimum tax per gallons (multiply line 15 by .04) 16 $
5. (attach form TC-110E) 5
17. Gallons subject to the additional tax from form
6. Utah tax paid purchases (attach form TC-110B) 6 TC-110K1 (attach TC-110K1 & TC-110K2) 122
17
00
7. TOTAL AVIATION FUEL AVAILABLE Additional tax on gallons from line 17 above
18.
7 18 $
(add lines 1 through 6) (multiply line 17 by .05)
00
Deductions TAX SUBTOTAL (add lines 16 and 18) 19 $
19.
Exported from Utah (attach form TC-110D1
00
2% allowance for evaporation, handling and
8. or TC-110D2) 8 20. 20 $
expense of collection (multiply line 19 by .02)
Qualified government sales (attach form
00
9. TC-110G and copies of invoice) 9 $
TAX TOTAL (subtract line 20 from 19)
21. 21
10. Exempt form TC-110F) distributors
sales to licensed
00
FOR AMENDED RETURNS ONLY - credit for
10
(attach 22. 22 $
tax paid on original return
00
11. Conversions to non-aviation fuel use 11 23 $
Penalty and Interest
23.
(attach form TC-110J)
00
TOTAL DUE (add lines 21 and 23)
24. 24 $
I declare under penalties of law to the best of my knowledge this is a true and correct return. File return, even if tax liability is ZERO for period
Authorized Signature Telephone Date
Return ENTIRE form, coupon, and payment to the Utah State Tax Commission
109A.FRM Rev. 7/01
Tax Type Account number Filing Period
Amount $
PAID
Make check or money order payable to the Utah State Tax
Commission. Do not send cash. Do not staple check to this
coupon. Put your account number on your check.
AVIATION FUEL TAX RETURN
UTAH STATE TAX COMMISSION
210 N 1950 W
SLC UT 84134-0540
*841340540*

2. Aviation Fuel Tax Return Instructions
Line 1. For Utah refiners only. Enter beginning refinery Line 12. Enter the amount shown on line 6.
inventory of aviation fuel for the month. This should be the Line 13. For Utah refiners only. Enter ending refinery
ending inventory of the previous month Aviation Fuel Return, inventory of aviation fuel for the month on this line. The
line 13. Do not include aviation fuel inventories at branch number of gallons reported on this line becomes next
locations. month's Aviation Fuel Return beginning inventory on line 1.
Line 2. Enter the total amount of aviation fuel manufactured, Line 14. Add lines 8 through 13 and enter the total on this line.
compounded, or blended during the month.
Line 15. Subtract line 14 from line 7 and enter the result on
Line 3. Enter the total amount of aviation fuel transferred this line.
from motor fuel. This amount should be the same as line 11
of the Motor Fuel Return, form TC-109. Only fuel sold at Line 16. Multiply line 15 by .04. Round to the nearest whole
airports for use in aircraft qualify as aviation fuel. dollar and enter on this line.
Line 4. This line applies to all aviation fuel imported to Utah Line 17. Gallons, from TC-110K1, subject to additional tax for
that you have title for as it enters the state. List all imports to aircraft that are NOT federally certificated air carriers for
Utah on Schedule A - Imports to Utah, form TC-110A and all-cargo or scheduled operations. For distribution purposes,
enter the total gallons on this line. you must attach forms TC-110K1 and TC-110K2.
Line 5. List all Utah purchases of aviation fuel from
Line 18. Additional tax on gallons from line 17. Multiply line
Utah-licensed distributors on Schedule E - Tax Exempt
17 by .05.
Purchases, form TC-110E and enter the total gallons on this
line. All pages of Schedule E should be grouped and Line 19. TAX SUBTOTAL (add lines 16 and 18)
subtotaled by seller.
Line 20. 2% tax allowance for evaporation, handling, and
Line 6. List all purchases of aviation fuel that have already
collection expense (multiply line 19 by .02).
been taxed by Utah (prior to the time of purchase) on
Schedule B - Tax Paid Purchases, form TC-110B and enter Line 21. TAX TOTAL (subtract line 20 from line 19).
the total gallons on this line and on line 12.
Line 22. FOR AMENDED RETURNS ONLY. On this line,
Line 7. Add lines 1 through 6 and enter the total gallons on enter the amount of credit for tax paid on the original tax
this line. return. If this is an amended return, check the AMENDED
box below the name and address field and enter the period
Line 8. This line applies to all aviation fuel you exported from being amended in the quot;Tax periodquot; field.
Utah that you (or your non-Utah licensed customer) have title
for as it leaves the state. List your exports for sale in another Line 23. If you want the Tax Commission to calculate
state on Schedule D1 - Exports from Utah, form TC-110D1. applicable penalty and interest, skip this line and complete
List non-Utah licensed customers' exports on Schedule D2 - line 22. If you would like to calculate penalty and interest,
Exports from Utah, form TC-110D2. Enter the combined total you may do so. Interest will be assessed at the rate
gallons of Schedule D1 and D2 on this line. Please attach prescribed by law from the original due date until paid in full.
duplicate copies of schedules D1 and D2 with your return. For interest information, taxpayers may request Applicable
For each load of fuel listed on Schedule D2, you must Interest Rates, form TC-15 by calling or writing the Utah
complete a Proof of Exportation, form TC-112 and retain it in State Tax Commission. Failure to file a return and/or pay the
your records. amount due is subject to penalties of $20 or 10 percent of
the amount due, whichever is the greater.
Line 9. List qualifying sales to government entities on
Line 24. TOTAL DUE. Add lines 21 and 23. Round to the
Schedule G - Exempt Sales to Government Entities, form
nearest whole dollars. (If this is an AMENDED return, first
TC-110G, and enter the total gallons on this line. Attach a
subtract line 22 from line 21 - for taxes already paid; then
copy of the original sales invoice for each sale listed on
add line 23 to the results and enter on this line.)
Schedule G. Refer to the Aviation Fuel Regulation for
additional information. Make check or money order payable to the Utah State Tax
Commission and enter that amount in the Amount Paid box
Line 10. List all Utah sales of aviation fuel to Utah-licensed
on the coupon at the bottom of the tax return. Do not send
distributors on Schedule F - Tax Exempt Sales, form
cash. Do not staple the check to the coupon. Do not separate
TC-110F, and enter the total gallons on this line. All pages of
the coupon - keep attached. Send the entire form, including
Schedule F should be grouped and subtotaled by customer.
coupon, and payment to Aviation Fuel Tax Return, Utah
Line 11. List all aviation fuel converted to non-aviation fuel State Tax Commission, 210 North 1950 West, Salt Lake City,
use on Schedule J - Jet Fuel Conversion to Non-Aviation Utah 84134-0540. If you have questions, please call (801)
Fuel Use, form TC-110J, and enter the total gallons on this 297-2200 or (800) 662-4335 if outside the Salt Lake City
line. If converted to motor fuel, show this amount on line 3 of area.
the Motor Fuel Return, form TC-109. If converted to special
fuel, show this amount on line 4 of the Special Fuel Supplier Aviation Fuel Tax Returns must be filed, even if no tax is due.
Return, form TC-364.
109AI.FRM 7/01