IFTA Quarterly Fuel Use Tax Return - Kentucky Transportation Cabinet

COMMONWEALTH OF KENTUCKY 2Q/2011 IFTA-100-MNTransportation CabinetDivision of Motor CarriersUse this form to report operations for theFrankfort, KY 40622 quarter ending 6/30/2011This report must be filed by the last day ofthe month following the end of the quarter.Date Rec'd/ProcessedLicensee IFTA Identification numberKYNameAddress changeStreet addressNo operation inany jurisdictionCity State Zip Code Cancel licenseAmended reportIFTA Quarterly Fuel Use Tax ReturnFile this report even if there is no tax due.Use this form for filing your Quarterly Fuel Use Tax Return as required under the International Fuel Taxagreement (IFTA). Read instructions carefully. Make a copy for your records.Attach check or money order payable to:KY STATE TREASUREREnter the amount ofyour payment hereSee Mailing Instructions. $Enter the Total Due from column Q of Form IFTA-101-MN, IFTA Quarterly Fuel Use Tax Schedule, for each fuel type.Enter any credit amounts in brackets. Attach a Form IFTA-101-MN for each fuel type reported below.1 Diesel . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1. . . . . . . . . . . .2 Motor fuel gasoline. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2. . . . . . . . . . . . . . . . .3 Ethanol/gasohol. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3. . . . . . . . . . . .4 Propane (LPG). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4. . . . . . . . . . . .5 All other fuel types not listed in lines 1 thru 4 (from worksheet on back of IFTA-101-I) . . 56 Subtotal of amount due or (credit) (add lines 1 through 5). . . . . . . . . . . . . . . 67 Penalty (see instructions). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7. . . . . . . . . . . . . .8 Total balance due or (credit) (add lines 6 and 7). . . . . . . . . . . . . . . . . . . . . . . . 89 Credits to be applied. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9. . . . . . . . . . . . . ")10 Balance due/(credit) (subtract line 9 from line 8). . . . . . . . . . . . . . . . . . . . . . . 1011 Refund amount requested. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 . . . . . . . . . . . . . .I certify that this business is duly licensed and that this report, including any schedules, is to the best of myknowledge and belief true, correct and complete.For Office Use OnlyAuthorized signature Date Taxpayer's phone number Sig CorrOfficial title Paid preparer's EIN Name/ID/AddressPaid preparer's name or firm (if other than taxpayer) Paid preparer's phone #Paid preparer's addressPaid preparer's signaturePlease make a copy of this report for your records.IFTA-100-MN (4/06)DateKYSee Mailing Instructions.Date Receivedhttp://transportation.ky.gov/dmc

Kentucky Transportation Cabinet 2Q/2011IFTA Quarterly Fuel Use Tax ScheduleIFTA-101Tax on Fuel Type: D (Diesel) Attach this schedule to Form IFTA-100, Use this form to report operationsIFTA Quarterly Fuel Use Tax Return. for the quarter ending 6/30/2011Prepare a separate schedule for each fuel type. Use Date due 7/31/2011additional sheets if necessary. Make a copy for your records.Date ProcessedLicensee IFTA Identification numberNameKYRound to the nearest whole gallon or mile. Read instructions (IFTA-101-I) carefully.Total Total Average(A) IFTA Miles + (B) Non-IFTA Miles = (C) Total Miles / (D) Total Gallons = (E) Fleet MPG(all IFTA and Non-IFTA jurisdictions)(2 decimal places)(A) (B) = (C) / (D) = (E)Enter credits in brackets([ ]).F G H I J K L M N O P QRate Taxable MPG Taxable Tax Paid Net Taxable Tax Tax (Credit) Due InterestJurisdiction Code IFTA Miles Miles from E Gallons Gallons Gallons Rate (col. M x N (Tax)) Due Total Dueabove (col. I / J) (col. K - L) (col. K x N (Surch)) (col. O + P)SubtotalsSubtotals from continuationTotals

Licensee IFTA Identification numberKYIFTA Quarterly Fuel Use Tax ScheduleUse this form to report operationsfor the quarter ending 6/30/2011DIESEL - Continuation-2 Date due 7/31/2011Date ProcessedNameTotal Total Average(A) IFTA Miles + (B) Non-IFTA Miles = (C) Total Miles / (D) Total Gallons = (E) Fleet MPG(all IFTA and Non-IFTA jurisdictions)(2 decimal places)(A) + (B) = (C) / (D) = (E)Enter credits in brackets([ ]).F G H I J K L M N O P QRate Taxable MPG Taxable Tax Paid Net Taxable Tax Tax (Credit) Due InterestJurisdiction Code IFTA Miles Miles from E Gallons Gallons Gallons Rate (col. M x N (Tax)) Due Total Dueabove (col. I / J) (col. K - L) (col. K x N (Surch)) (col. O + P)Totals

Licensee IFTA Identification numberKYIFTA Quarterly Fuel Use Tax ScheduleUse this form to report operationsfor the quarter ending 6/30/2011DIESEL - Continuation-3 Date due 7/31/2011Date ProcessedNameTotal Total Average(A) IFTA Miles + (B) Non-IFTA Miles = (C) Total Miles / (D) Total Gallons = (E) Fleet MPG(all IFTA and Non-IFTA jurisdictions)(2 decimal places)(A) + (B) = (C) / (D) = (E)Enter credits in brackets([ ]).F G H I J K L M N O P QRate Taxable MPG Taxable Tax Paid Net Taxable Tax Tax (Credit) Due InterestJurisdiction Code IFTA Miles Miles from E Gallons Gallons Gallons Rate (col. M x N (Tax)) Due Total Dueabove (col. I / J) (col. K - L) (col. K x N (Surch)) (col. O + P)Total

Kentucky Transportation Cabinet 2Q/2011IFTA Quarterly Fuel Use Tax ScheduleIFTA-101Tax on Fuel Type: G (Gasoline) Attach this schedule to Form IFTA-100, Use this form to report operationsIFTA Quarterly Fuel Use Tax Return. for the quarter ending 6/30/2011Prepare a separate schedule for each fuel type. Use Date due 7/31/2011additional sheets if necessary. Make a copy for your records.Date ProcessedLicensee IFTA Identification numberNameKYRound to the nearest whole gallon or mile. Read instructions (IFTA-101-I) carefully.Total Total Average(A) IFTA Miles + (B) Non-IFTA Miles = (C) Total Miles / (D) Total Gallons = (E) Fleet MPG(all IFTA and Non-IFTA jurisdictions)(2 decimal places)(A) + (B) = (C) / (D) = (E)Enter credits in brackets([ ]).F G H I J K L M N O P QRate Taxable MPG Taxable Tax Paid Net Taxable Tax Tax (Credit) Due InterestJurisdiction Code IFTA Miles Miles from E Gallons Gallons Gallons Rate (col. M x N (Tax)) Due Total Dueabove (col. I / J) (col. K - L) (col. K x N (Surch)) (col. O + P)Sub totalsSubtotals from continuationTotals

Licensee IFTA Identification numberKYIFTA Quarterly Fuel Use Tax ScheduleUse this form to report operationsfor the quarter ending 6/30/2011GASOLINE - Continuation-2 Date due 7/31/2011Date ProcessedNameTotal Total Average(A) IFTA Miles + (B) Non-IFTA Miles = (C) Total Miles / (D) Total Gallons = (E) Fleet MPG(all IFTA and Non-IFTA jurisdictions)(2 decimal places)(A) + (B) = (C) / (D) = (E)Enter credits in brackets([ ]).F G H I J K L M N O P QRate Taxable MPG Taxable Tax Paid Net Taxable Tax Tax (Credit) Due InterestJurisdiction Code IFTA Miles Miles from E Gallons Gallons Gallons Rate (col. M x N (Tax)) Due Total Dueabove (col. I / J) (col. K - L) (col. K x N (Surch)) (col. O + P)Totals

JD Jurisdiction FUEL_TYPE G-Gasoline-Rate G-Gasoline-US Code Tax Rate SurchargeAB Alberta GASOLINE 0064 0.3486 NAL Alabama GASOLINE 0062 0.16 NAR Arkansas GASOLINE 0064 0.215 NAZ Arizona GASOLINE 0064 0.18 NBC British Columbia GASOLINE 0063 0.734 NCA California GASOLINE 0062 0 NCO Colorado GASOLINE 0064 0.22 NCT Connecticut GASOLINE 0062 0.25 NDE Delaware GASOLINE 0060 0.23 NFL Florida GASOLINE 0064 0.2987 NGA Georgia GASOLINE 67 0.151 NIA Iowa GASOLINE 0064 0.21 NID Idaho GASOLINE 0062 0 NIL Illinois GASOLINE 0064 0.34 NIN Indiana GASOLINE 0127 0.18 NIN* SURCHARGE GASOLINE 0128 0.11 YKS Kansas GASOLINE 0064 0.24 NKY Kentucky GASOLINE 0119 0.245 NKY* SURCHARGE GASOLINE 0120 0.043 YLA Louisiana GASOLINE 0064 0.2 NMA Massachusetts GASOLINE 0062 0.21 NMB Manitoba GASOLINE 0064 0.4455 NMD Maryland GASOLINE 0062 0.235 NME Maine GASOLINE 0058 0 NMI Michigan GASOLINE 0063 0 NMN Minnesota GASOLINE 0065 0.275 NMO Missouri GASOLINE 0063 0.17 NMS Mississippi GASOLINE 0064 0.18 NMT Montana GASOLINE 0064 0 NNB New Brunswick GASOLINE 0062 0.5268 NNC North Carolina GASOLINE 0064 0.325 NND North Dakota GASOLINE 0064 0.23 NNE Nebraska GASOLINE 0064 0.264 NNH New Hampshire GASOLINE 0058 0 NNJ New Jersey GASOLINE 0060 0.145 NNL Newfoundland GASOLINE 0062 0.6391 NNM New Mexico GASOLINE 0062 0 NNS Nova Scotia GASOLINE 0063 0.6004 NNV Neveda GASOLINE 0062 0.23 NNY New York GASOLINE 0062 0.41 NOH Ohio GASOLINE 0104 0.28 NOK Oklahoma GASOLINE 0064 0.16 NON Ontario GASOLINE 0058 0.5694 NOR Oregon GASOLINE 0062 0 NPA Pennsylvania GASOLINE 0069 0.312 NPE Prince Edward Island GASOLINE 0063 0.612 NQC Quebec GASOLINE 0062 0.6662 NRI Rhode Island GASOLINE 0060 0.32 NSC South Carolina GASOLINE 0062 0.16 NSD South Dakota GASOLINE 0062 0 NSK Saskatchewan GASOLINE 0064 0.581 N

TN Tennessee GASOLINE 0064 0.2 NTX Texas GASOLINE 0064 0.2 NUT Utah GASOLINE 0064 0.245 NVA* SURCHARGE GASOLINE 0124 0.035 YVA Virginia GASOLINE 0123 0.175 NVT Vermont GASOLINE 0059 0 NWA Washington GASOLINE 0064 0.375 NWI Wisconsin GASOLINE 0064 0.329 NWV West Virginia GASOLINE 0062 0.322 NWY Wyoming GASOLINE 0064 0.14 NGA** RATE CHANGE GASOLINE 68 0.172 R0 0 0 0 0 00 0 0 0 0 00 0 0 0 0 00 0 0 0 0 00 0 0 0 0 00 0 0 0 0 00 0 0 0 0 00 0 0 0 0 00 0 0 0 0 00 0 0 0 0 00 0 0 0 0 00 0 0 0 0 00 0 0 0 0 00 0 0 0 0 00 0 0 0 0 00 0 0 0 0 0

JD Jurisdiction FUEL_TYPE D-Diesel-Rate D-Diesel-US Code Tax Rate SurchargeAB Alberta DIESEL 0064 0.3486 NAL Alabama DIESEL 0062 0.19 NAR Arkansas DIESEL 0064 0.225 NAZ Arizona DIESEL 0073 0.26 NBC British Columbia DIESEL 0063 0.779 NCA California DIESEL 0062 0.397 NCO Colorado DIESEL 0064 0.205 NCT Connecticut DIESEL 0063 0.396 NDE Delaware DIESEL 0060 0.22 NFL Florida DIESEL 0064 0.3207 NGA Georgia DIESEL 63 0.16 NIA Iowa DIESEL 0064 0.225 NID Idaho DIESEL 0064 0.25 NIL Illinois DIESEL 0064 0.378 NIN Indiana DIESEL 0127 0.16 NIN* SURCHARGE DIESEL 0128 0.11 YKS Kansas DIESEL 0064 0.26 NKY Kentucky DIESEL 0119 0.215 NKY* SURCHARGE DIESEL 0120 0.102 YLA Louisiana DIESEL 0064 0.2 NMA Massachusetts DIESEL 0062 0.21 NMB Manitoba DIESEL 0065 0.4455 NMD Maryland DIESEL 0062 0.2425 NME Maine DIESEL 0059 0.307 NMI Michigan DIESEL 0086 0.373 NMN Minnesota DIESEL 0065 0.275 NMO Missouri DIESEL 0064 0.17 NMS Mississippi DIESEL 0064 0.18 NMT Montana DIESEL 0064 0.2775 NNB New Brunswick DIESEL 0062 0.7437 NNC North Carolina DIESEL 0064 0.325 NND North Dakota DIESEL 0064 0.23 NNE Nebraska DIESEL 0064 0.264 NNH New Hampshire DIESEL 0058 0.18 NNJ New Jersey DIESEL 0060 0.175 NNL Newfoundland DIESEL 0062 0.6391 NNM New Mexico DIESEL 0064 0.21 NNS Nova Scotia DIESEL 0062 0.5965 NNV Neveda DIESEL 0064 0.27 NNY New York DIESEL 0062 0.3925 NOH Ohio DIESEL 0104 0.28 NOK Oklahoma DIESEL 0064 0.13 NON Ontario DIESEL 0058 0.5539 NOR Oregon DIESEL 0062 0 NPA Pennsylvania DIESEL 0069 0.381 NPE Prince Edward Island DIESEL 0063 0.7824 NQC Quebec DIESEL 0064 0.705 NRI Rhode Island DIESEL 0060 0.32 NSC South Carolina DIESEL 0062 0.16 NSD South Dakota DIESEL 0064 0.22 NSK Saskatchewan DIESEL 0064 0.581 N

TN Tennessee DIESEL 0064 0.17 NTX Texas DIESEL 0064 0.2 NUT Utah DIESEL 0064 0.245 NVA* SURCHARGE DIESEL 0124 0.035 YVA Virginia DIESEL 0123 0.175 NVT Vermont DIESEL 0072 0.29 NWA Washington DIESEL 0064 0.375 NWI Wisconsin DIESEL 0064 0.329 NWV West Virginia DIESEL 0062 0.322 NWY Wyoming DIESEL 0064 0.14 NGA** RATE CHANGE DIESEL 64 0.183 R0 0 0 0 0 00 0 0 0 0 00 0 0 0 0 00 0 0 0 0 00 0 0 0 0 00 0 0 0 0 00 0 0 0 0 00 0 0 0 0 00 0 0 0 0 00 0 0 0 0 00 0 0 0 0 00 0 0 0 0 00 0 0 0 0 00 0 0 0 0 00 0 0 0 0 00 0 0 0 0 0