Claims for state motor fuel tax refunds shall be sworn to and be filed with the Commissioner of Revenue on forms to be prepared and distributed by the commissioner. The forms shall be substantially as follows:
CLAIM FOR REFUND OF STATE TAX ON MOTOR FUEL USED ON A FARM FOR AGRICULTURAL PURPOSES.
1. Name __________________________
Address (Number and street or rural route) ____________________
(City, town, or post office) ______________ (Zone)
_______________ (State) ____.
2. Total number of gallons of motor fuel purchased after December 31, 2__, and before January 1, 2__, for farming purposes, and for which a claim has been filed for a refund of the federal tax on motor fuel under Public Law 466, H.R. 8780, 84th Congress, Chapter 160, 2nd Session _____ gallons.
3. Total number of gallons of motor fuel purchased after December 31, 2__, and before January 1, 2__, for use for agricultural purposes _____ gallons.
4. Rate of refund of state tax (per gallon), ________ $.11.
5. Subtotal of refund claimed (line 3 multiplied by line 4) $__________.
6. Total number of gallons of motor fuel purchased after December 31, 2___, and before January 1, 2__, to transport any biomass from a farm to a facility at which the biomass is used in the generation of electricity from renewable energy resources ______ gallons.
7. Rate of refund of state tax (per gallon) _________$.11.
8. Subtotal of refund claimed (line 6 multiplied by line 7) $__________.
9. Enter the lesser of line 8 or $1,000 $____________.
10. Total refund claimed (line 5 plus line 9) $__________.
11. The names and addresses of all retailers, refiners, or distributors from whom the motor fuel for which the refund is being claimed was purchased, together with the dates and number of the invoices covering the total number of gallons of motor fuel on which the refund is being claimed (attach sheet or enter on reverse side of this form).
I declare under the penalties of perjury that this claim has been examined by me and to the best of my knowledge and belief is true and correct, and that the number of gallons shown in items 3 and 6 do not exceed the total number of gallons of motor fuel on which I am legally entitled, under the laws of this state, to a refund of a portion of the state tax paid.
Signed: _______________________
Date: _________________________
Sworn and subscribed before me this the _______ day of ___________, 2__."
(Acts 1957, No. 743, p. 1173, §4; Acts 1959, No. 416, p. 1104, §2; Acts 1969, No. 1155, p. 2160; Acts 1992, No. 92-203, p. 486, §6; §40-17-103; amended and renumbered by Act 2008-275, p. 402, §6.)
Claims for state motor fuel tax refunds shall be sworn to and be filed with the Commissioner of Revenue on forms to be prepared and distributed by the commissioner. The forms shall be substantially as follows:
CLAIM FOR REFUND OF STATE TAX ON MOTOR FUEL USED ON A FARM FOR AGRICULTURAL PURPOSES.
1. Name __________________________
Address (Number and street or rural route) ____________________
(City, town, or post office) ______________ (Zone)
_______________ (State) ____.
2. Total number of gallons of motor fuel purchased after December 31, 2__, and before January 1, 2__, for farming purposes, and for which a claim has been filed for a refund of the federal tax on motor fuel under Public Law 466, H.R. 8780, 84th Congress, Chapter 160, 2nd Session _____ gallons.
3. Total number of gallons of motor fuel purchased after December 31, 2__, and before January 1, 2__, for use for agricultural purposes _____ gallons.
4. Rate of refund of state tax (per gallon), ________ $.11.
5. Subtotal of refund claimed (line 3 multiplied by line 4) $__________.
6. Total number of gallons of motor fuel purchased after December 31, 2___, and before January 1, 2__, to transport any biomass from a farm to a facility at which the biomass is used in the generation of electricity from renewable energy resources ______ gallons.
7. Rate of refund of state tax (per gallon) _________$.11.
8. Subtotal of refund claimed (line 6 multiplied by line 7) $__________.
9. Enter the lesser of line 8 or $1,000 $____________.
10. Total refund claimed (line 5 plus line 9) $__________.
11. The names and addresses of all retailers, refiners, or distributors from whom the motor fuel for which the refund is being claimed was purchased, together with the dates and number of the invoices covering the total number of gallons of motor fuel on which the refund is being claimed (attach sheet or enter on reverse side of this form).
I declare under the penalties of perjury that this claim has been examined by me and to the best of my knowledge and belief is true and correct, and that the number of gallons shown in items 3 and 6 do not exceed the total number of gallons of motor fuel on which I am legally entitled, under the laws of this state, to a refund of a portion of the state tax paid.
Signed: _______________________
Date: _________________________
Sworn and subscribed before me this the _______ day of ___________, 2__."
(Acts 1957, No. 743, p. 1173, §4; Acts 1959, No. 416, p. 1104, §2; Acts 1969, No. 1155, p. 2160; Acts 1992, No. 92-203, p. 486, §6; §40-17-103; amended and renumbered by Act 2008-275, p. 402, §6.)
Claims for state motor fuel tax refunds shall be sworn to and be filed with the Commissioner of Revenue on forms to be prepared and distributed by the commissioner. The forms shall be substantially as follows:
CLAIM FOR REFUND OF STATE TAX ON MOTOR FUEL USED ON A FARM FOR AGRICULTURAL PURPOSES.
1. Name __________________________
Address (Number and street or rural route) ____________________
(City, town, or post office) ______________ (Zone)
_______________ (State) ____.
2. Total number of gallons of motor fuel purchased after December 31, 2__, and before January 1, 2__, for farming purposes, and for which a claim has been filed for a refund of the federal tax on motor fuel under Public Law 466, H.R. 8780, 84th Congress, Chapter 160, 2nd Session _____ gallons.
3. Total number of gallons of motor fuel purchased after December 31, 2__, and before January 1, 2__, for use for agricultural purposes _____ gallons.
4. Rate of refund of state tax (per gallon), ________ $.11.
5. Subtotal of refund claimed (line 3 multiplied by line 4) $__________.
6. Total number of gallons of motor fuel purchased after December 31, 2___, and before January 1, 2__, to transport any biomass from a farm to a facility at which the biomass is used in the generation of electricity from renewable energy resources ______ gallons.
7. Rate of refund of state tax (per gallon) _________$.11.
8. Subtotal of refund claimed (line 6 multiplied by line 7) $__________.
9. Enter the lesser of line 8 or $1,000 $____________.
10. Total refund claimed (line 5 plus line 9) $__________.
11. The names and addresses of all retailers, refiners, or distributors from whom the motor fuel for which the refund is being claimed was purchased, together with the dates and number of the invoices covering the total number of gallons of motor fuel on which the refund is being claimed (attach sheet or enter on reverse side of this form).
I declare under the penalties of perjury that this claim has been examined by me and to the best of my knowledge and belief is true and correct, and that the number of gallons shown in items 3 and 6 do not exceed the total number of gallons of motor fuel on which I am legally entitled, under the laws of this state, to a refund of a portion of the state tax paid.
Signed: _______________________
Date: _________________________
Sworn and subscribed before me this the _______ day of ___________, 2__."
(Acts 1957, No. 743, p. 1173, §4; Acts 1959, No. 416, p. 1104, §2; Acts 1969, No. 1155, p. 2160; Acts 1992, No. 92-203, p. 486, §6; §40-17-103; amended and renumbered by Act 2008-275, p. 402, §6.)
