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Department of Revenue Services Form OP-216
PO Box 5031
Hartford CT 06102-5031 Special Fuel Tax Return
(Rev. 06/18)
OP216 0618W 01 9999

 Due on or before Connecticut Tax Registration Number
Return for period ended
M M - D D - Y Y Y Y M M - D D - Y Y Y Y 
Name
Federal Employer Identification Number

Street address
Out of business 
City/town State Zip Code

Amended return

Complete the return in blue or black ink.
Section 1 - Special Fuels Gallons Accountability
1. Opening physical inventory: Must agree with prior month’s closing inventory. 1. 

2. Gallons purchased, state excise tax paid within Connecticut: Attach Form MF-R, Schedule 1. 2. 

3. Gallons purchased, state excise tax unpaid within Connecticut: Attach Form MF-R, Schedule 2. 3. 

4. Gallons imported direct to customers within Connecticut: Attach Form MF-R, Schedule 3. 4. 

5. Gallons imported into Connecticut storage: Attach Form MF-R, Schedule 4. 5. 

6. Gallons available for sale or use: Add Lines 1 through 5. 6. 

7. Closing physical inventory: Include in-transit items. 7. 

8. Total gallons to be accounted for: Subtract Line 7 from Line 6. 8. 

9. Nontaxable sales and transfers to licensed distributors: Attach Form MF-D, Schedule 6. 9. 
10. Sales and transfers out of Connecticut and sales in Connecticut for immediate export from
Connecticut: Attach Form MF-D, Schedule 7. 10. 

11. Gallons sold to U.S. government tax exempt: Attach Form MF-D, Schedule 8. 11. 

12. Gallons sold to state and local government tax exempt: Attach Form MF-D, Schedule 9. 12. 
13. Sales to farmers or other tax exempt entities, nontaxable uses, sales of jet fuel, sales
of #2 heating oil and kerosene for heating purposes, and sales of dyed diesel fuel for
marine purposes: Attach Form MF-D, Schedule 10. 13. 

14. Gain or loss from inventory variation: Show gain as negative and deduct. 14. 

15. Total nontaxable sales and uses: Add Lines 9 through 14. 15. 

16. Taxable sales other than to licensed distributors. 16. 

17. Taxable sales to licensed distributors: Attach Form MF-D, Schedule 5. 17. 

18. Taxable uses. 18. 

19. Total taxable sales and uses: Add Lines 16, 17, and 18. 19. 

20. Total gallons accounted for: Add Line 19 and Line 15; the sum must equal Line 8. 20. 

Complete Sections 2 and 3 on the reverse side.

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Form OP-216 Connecticut Tax
Page 2 of 4 Registration Number
(Rev. 06/18)
OP216 0618W 02 9999

Section 2 - Special Fuels Tax Calculation
Column A - Diesel Column B - Alternative Fuel

21 Taxable gallons. 21.  

22. Deduct tax paid purchases. 22.  

23. Deduct dealer sales to governmental
entities: Attach Form MF-D, Schedule 13. 23.  

24. Total taxable gallons: Subtract Line 22 and
Line 23 from Line 21 for each column. 24.  

25. Tax due: Multiply Line 24 by the rate
(Column A by 43.9¢; Column B by 26¢) 25.  .00  .00

26. Total tax due: Add Line 25, Column A and Column B. 26.  .00

27. Penalty: 10% (.10) of total tax due or $50, whichever is greater. 27.  .00

28. Interest: 1% (.01) per month or fraction of a month from due date to date of payment. 28.  .00

29. Total amount due: Add Lines 26, 27, and 28. 29.  .00

Section 3 - Declaration and Signature
Declaration: I declare under penalty of law that I have examined this return (including any accompanying schedules and statements) and, to the best of
my knowledge and belief, it is true, complete, and correct. I understand the penalty for willfully delivering a false return or document to the Department of
Revenue Services (DRS) is a fine of not more than $5,000, or imprisonment for not more than five years, or both. The declaration of a paid preparer other
than the taxpayer is based on all information of which the preparer has any knowledge.

Taxpayer signature Title Date (MMDDYYYY)
Sign Here

Keep a Print taxpayer name Telephone number Taxpayer SSN
copy of
this return
for your
Paid preparer signature Preparer address Preparer’s SSN or PTIN
records.

Taxpayer’s email address


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Form OP-216 - Instructions
General Instructions Line Instructions
Complete the return in blue or black ink only. Line 2
Taxpayers must file a return for each calendar month by the Report Connecticut state excise tax paid purchases of
twenty-fifth day of the following month. If the due date falls on diesel fuel, #2 heating oil, kerosene, jet fuel, and biodiesel
a Saturday, Sunday, or legal holiday, the next business day and purchases of propane and natural gas sold as a motor
is the due date. A return must be filed even if no tax is due. vehicle fuel. For each product code, you must complete a
Rounding gallons: On your return, you must round off separate Form MF-R, Motor Vehicle Fuels Tax Schedule
fractions of a gallon to the nearest whole gallon. Round down of Receipts, Schedule Type 1, indicating gallons purchased
to the next lowest whole gallon all fractions of a gallon less from each supplier.
than a half gallon. Round up to the next highest whole gallon Line 3
all fractions of a half gallon or more. Report Connecticut state excise tax unpaid purchases of
You must round off cents to the nearest whole dollar on diesel fuel, #2 heating oil, kerosene, jet fuel, and biodiesel
your return and schedules. If you do not round, DRS will and purchases of propane and natural gas sold as a motor
disregard the cents. Round down to the next lowest dollar vehicle fuel. For each product code, you must complete a
all amounts that include 1 through 49 cents. Round up to separate Form MF-R, Schedule Type 2, indicating gallons
the next highest dollar all amounts that include 50 through purchased from each supplier.
99 cents. However, if you need to add two or more amounts
to compute the amount to enter on a line, include cents and Line 4
round off only the total. Report gallons imported from another state direct to customers
within Connecticut. For each product code, you must complete
Pay Electronically : Visit www.ct.gov/TSC to use the
a separate Form MF-R, Schedule Type 3, indicating gallons
Taxpayer Service Center (TSC) to make a direct tax
purchased from each supplier.
payment. After logging onto the TSC, select the Make
Payment Only option and choose a tax type from the drop Line 5
down box. Using this option authorizes the Department of Report gallons imported from another state into Connecticut
Revenue Services (DRS) to electronically withdraw from storage. For each product code, you must complete a
your bank account (checking or savings) a payment on a separate Form MF-R, Schedule Type 4, indicating gallons
date you select up to the due date. As a reminder, even if purchased from each supplier.
you pay electronically you must still file your return by the due
date. Tax not paid on or before the due date will be subject Line 9
to penalty and interest. Report Connecticut state excise tax-exempt sales and
transfers of diesel fuel, #2 heating oil, kerosene, jet fuel,
Pay by Mail: Make check payable to Commissioner of
biodiesel, propane, and natural gas to licensed diesel fuel
Revenue Services. To ensure payment is applied to your
distributors. For each product code, you must complete a
account, write “Form OP-216” and your Connecticut Tax
separate
Registration Number, optional, on the front of your check. Form MF-D, Motor Vehicle Fuels Tax Schedule of
Disbursements, Schedule Type 6, indicating gallons sold to
Be sure to sign your check and paper clip it to the front of
your return. Do not send cash. DRS may submit your check Announcement 2018(3), Annual List of
each customer. See
Distributors for Motor Vehicle Fuels Tax Purposes , for a list
to your bank electronically.
of licensed distributors.
Mail this return and schedules with a check to:
Department of Revenue Services Line 10
State of Connecticut Report sales and transfers out of Connecticut and sales in
PO Box 5031 Connecticut to licensed motor vehicle fuels exporters. For
Hartford CT 06102-5031 each product code, you must complete a separate Form MF-D,
Schedule Type 7, indicating gallons sold to each customer.
Line 11
Special Instructions for Sellers of
Report tax-exempt sales to the U.S. government. For each
Certain Alternative Fuel
product code, you must complete a separate Form MF-D,
Effective for sales made on or after July 1, 2008, sales Schedule Type 8, indicating gallons sold to each branch of
of compressed natural gas, liquefied petroleum gas, and the U.S. government.
liquefied natural gas (alternative fuels) are subject to motor
vehicle fuels tax at 26¢ per gallon. When selling such fuels Line 12
in a gaseous form, see Special Notice 2018(2), Conversion Report tax-exempt sales to the State of Connecticut and
Factors on Motor Vehicle Fuels Occurring in Gaseous Form municipalities of this state. For each product code, you must
Beginning July 1, 2018. complete a separate Form MF-D, Schedule Type 9, indicating
gallons sold to each state agency and each municipality.

Form OP-216 (Rev. 06/18) Page 3 of 4

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Form OP-216 - Instructions (continued)
Line 13 Column B
Report tax-exempt sales to farmers and other tax-exempt Report all alternative fuel credit card sales to governmental
purchasers. Report tax-exempt sales of jet fuel to licensed entities made at retail outlets. For each product code, you
aviation fuel dealers or sold directly to an aircraft owner or must complete a separate Form MF-D, Schedule Type 13,
operator documented by Form AU-477, Aircraft Owner or indicating alternative fuel gallons sold to each governmental
Operator Declaration Motor Vehicle Fuels Tax Exemption. entity.
Report tax-exempt sales to any vessel having a displacement Line 24
exceeding four thousand (4,000) dead weight tons or primarily Total taxable gallons: Subtract Line 22 and Line 23 from Line 21
engaged in interstate commerce. Report tax-exempt sales for Column A (diesel) and Column B (alternative fuel).
of dyed diesel fuel to a licensed marine fuel dock owner or
operator documented by Form AU-478. Line 25 - Tax Due
For each product code, you must complete a separate Form Column A
MF-D, Schedule Type 10, indicating to whom the gallons Multiply Line 24, Column A by 43.9¢
were sold. Include nontaxable use and tax-exempt sales of Column B
#2 heating oil and kerosene for heating purposes, but do not Multiply Line 24, Column B by 26¢.
complete Form MF-D for such sales.
Line 26
Line 16 Total tax due: Add Line 25, Column A and line 25, Column B.
Report all taxable sales other than to licensed distributors.
Do not complete Form MF-D. Line 27
Late Payment Penalty: The penalty for late payment is 10%
Line 17 of tax due or $50, whichever is greater.
Report taxable sales to licensed diesel fuel distributors. For
Late Filing Penalty: The Commissioner of Revenue Services
each product code, you must complete a separate Form MF-D,
may impose a $50 penalty for failure to file any return required
Schedule Type 5, indicating gallons sold to each licensed by law to be filed.
diesel fuel distributor.
Line 28
Line 18
Interest: The interest charge for late payment is 1% per month
Report all taxable use.
or fraction of a month from the due date.
Line 21
Line 29
Column A Remit the amount due with this return.
Report the diesel gallons included in Line 19.
Column B For Further Information
Report the alternative fuel gallons included in Line 19. If you need additional information or assistance, call the
Excise Taxes Unit at 860-541-3224, Monday through Friday
Line 22
8:30 a.m. to 4:30 p.m.
Column A
Of the taxable gallons on Line 21, Column A, report those diesel For More Information: Call DRS during business hours,
gallons that were purchased as state excise tax-paid, as reported Monday through Friday:
on Form MF-R, Schedule Type 1. • 1-800-382-9463 (Connecticut calls outside the Greater
Hartford calling area only); or
Column B
Of the taxable gallons on Line 21, Column B, report those • 860-297-5962 (from anywhere).
alternative fuel gallons that were purchased as state excise TTY, TDD, and Text Telephone users only may transmit
tax-paid, as reported on Form MF-R, Schedule Type 1. inquiries anytime by calling 860-297-4911.
Line 23 Forms and Publications: Visit the DRS website at
www.ct.gov/DRS to download and print Connecticut tax
Column A
forms and publications.
Report all diesel credit card sales to governmental entities
made at retail outlets. For each product code, you must
complete a separate Form MF-D, Schedule Type 13,
indicating diesel gallons sold to each governmental entity.

Form OP-216 (Rev.06/18) Page 4 of 4

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