On or before the 20th day of each month after April 11, 2002, every person upon whom the excise tax is levied shall render to the County Commission of Lauderdale County on forms prescribed by the county commission a true and correct statement of all sales and withdrawals of gasoline made by him, her, or them during the next preceding month, liable for payment of the excise tax imposed pursuant to this subpart, and shall furnish to the Lauderdale County Commission such additional information as the Lauderdale County Commission may require upon blanks to be formulated and furnished by the Lauderdale County Commission, and at the time of making such report shall pay to the Lauderdale County Commission an amount of money equal to the excise tax levied under this subpart. The statement herein required to be made by the distributor, storer, or retail dealer shall be sworn to before some officer authorized to administer oaths, and any false statement sworn to shall constitute perjury and upon conviction thereupon the person so convicted shall be punished as provided by law for the crime of perjury.