Heating Oil Insurance Fee Return
For validation only - 545-030-141-0001
Validated postmark date
Heating Oil Insurance Fee Return
If payment is enclosed, send this completed form and supporting
documents to: Prorate and Fuel Tax, Department of Licensing, PO Box 3777,
Seattle, WA 98124-3777
If payment is not enclosed, send this completed form and supporting
documents to: Fuel Tax Unit, Department of Licensing, PO Box 9228,
Olympia, WA 98507-9228 or fax to (360) 570-7842
A. Annual reporting period
Year Account number
B. No operations Amended return
C. Name and address
Heating oil sales
1 Diesel 1
2 Kerosene 2
3 Stove oil 3
4 Other (explain) 4
5 Total heating fuel distributed (Add lines 1 through 4) 5
6 Amount due (line 5 x $ .012) 6
7 Previous payment for this reporting period 7
8 If total of line 6 - line 7 is greater than zero, amount owed EFT 8
9 If total of line 6 - line 7 is less than zero, net refund amount 9 ( )
Printed name of person signing Contact name (If different from person signing)
Contact (area code) telephone number Contact (area code) fax number Contact email address
I certify under penalty of perjury under the laws of the state of Washington that the foregoing is true and correct.
Date and place Signature
Please keep a copy of this tax return for your records.
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Click here to START or CLEAR, then hit the TAB button
When you have completed this form, please print it out and sign here.
If you sell heating oil, you must complete the Washington Heating Oil Insurance Fee Return. For the purposes of this
return, “Heating Oil” is deﬁned as any petroleum product used for space heating in oil-ﬁred furnaces, heaters, and boilers,
including stove oil, diesel fuel, or kerosene. Returns must be ﬁled annually. Payment of the net amount due the state must
accompany the return.
• Returns are due January 25th of the year following the reporting period. The postal service postmark on the mailing
envelope is used as the day of receipt.
• Round all reported gallons to the nearest whole gallon. Convert liters to gallons at the rate of 3.785 liters per gallon.
• The person signing the return must be authorized by the company to do so.
• No operations: If you had no activity during the reporting period, you must ﬁle a return in order to avoid revocation.
• Amended return: To report changes for a previous ﬁling, use a new return and mark “Amended Return”. Complete
the entire return using the corrected ﬁgures. Record any payments made with the original return on line 7 and continue
ﬁlling out the return.
• Name change: Provide your current business name. If you purchased or incorporated your business, a new application
for license must be completed.
• Address change: Provide physical and mailing addresses.
• Cancel license and effective date: The effective date is the date you stopped business operations. Returns must be
ﬁled through this date.
Line 1 - Line 4 Enter the total gallons sold for heating purposes in the appropriate lines.
Line 5 Add lines 1 through 4.
Line 6 Multiply the amount on line 5 by $ .012.
Line 7 Enter all payments you have previously made for this reporting period.
Line 8 If line 6 minus line 7 is greater than zero, this is the amount owed.
Line 9 If line 6 minus line 7 is less than zero, this is the refund amount.
• All payments must be made in U.S. funds.
• Payments are due January 25th of the year following the reporting period.
• If you are paying via electronic funds transfer (EFT), place an “X” in the EFT box.
Records must be kept for ﬁve years for all heating oil received, sold, distributed, or used for own consumption. These
include invoices, bills of lading, and other papers. Information may be disclosed to the Internal Revenue Service.
For questions related to completing this form, call 360-664-1852.
For questions regarding legal requirements, contact Washington Pollution Liability Insurance Agency at:
Phone: (800) 822-3905 or (360) 407-0520.
Voice Mail: (360) 407-0516
Website: [email protected]
FT-441-246 (R/10/13)WA Page 2 of 2