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Utah State Tax Commission
TC -115
Reconciliation of Petroleum Rev. 11/94
Product Purchases
Telephone: (801) 297-2200 for assistance
(1-800-662-4335 outside Salt Lake City but inside Utah)
Name, address, city, state, and ZIP code. Correct any errors. Filing year
Tax period
Social Security (individual) or
Federal ID number (business)
Who should file this form
Every final consumer of a petroleum product who purchases petroleum products exempt from the environmental
surcharge fee must file this form on an annual basis.
Definition for Line 1
Exempt storage tanks include, but are not limited to, the following:
Above-ground tanks in which the volume, including the volume in the underground connecting pipes, is
90 percent or more above ground and is not used to store products for sale;
Underground tanks with a storage capacity of 110 or fewer gallons;
Farm or residential tanks with a capacity of 1,100 gallons or less, used for storing petroleum products
for noncommercial purposes;
Tanks used for storing heating oil for consumptive use on the premises where stored;
Storage tanks in an underground area, such as a basement, cellar, mine working, drift, shaft, or tunnel, if
the tanks are situated upon or above the surface of the floor.
1. Total gallons purchased exempt, but not stored in an exempt storage tank
2. Surcharge per gallon .005
3. Total tax due
I certify that this application has been examined by me and to the best of my knowledge is a true, correct, and
complete return.
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TC-115.CDR