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Utah State Tax Commission

Selection of Reporting Basis for Motor Fuel, Aviation Fuel and Special Fuel Gallons

TC-106 Rev. 10/03

Complete this form to indicate a change in your tax reporting election. The declared basis must be the exclusive basis used to report your fuel tax liability to the Tax Commission. Changes to your reporting basis may only occur on January 1 and must remain in effect until the following January 1. Consistent with R865-13G-11 and R865-4D-21, "Gross gallons" means the U.S. volumetric gallon with a liquid capacity of 231 cubic inches. "Net gallons" means the gross metered gallon with temperature correction in volume to 60 degrees Fahrenheit. If you select "Net gallons" all invoices, manifests, bills-of-lading and fuel tax returns must include both gross and net gallon amounts. Conversion from gallons must conform to the ASTM-API-IP Petroleum Measurement Tables.

Legal owner's name (individual, corporation, or partnership)

Telephone number

DBA (if different from above)

Fuel tax account number

Mailing address (street address, city, state, and ZIP code)

Indicate the effective date and select the desired reporting basis Effective date: January 1, _________ Gross gallons Net gallons

Designate which fuel type(s) will be affected by the change in this fuel tax reporting election.
Motor fuel Aviation fuel Special fuel

I understand that I may not make future changes in my reporting basis before January 1st of the following year. Signature of individual/representative
X

Date signed

Title