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Consolidated Application For Fuel Tax Refund REF-1000 - Indiana
| Consolidated Application For Fuel Tax Refund Form. This is a Indiana form and can be used in Refund Fuel And Environmental Department Of Revenue Statewide . |
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Indiana Department of Revenue Form REF-1000 State Form 50854 (R2/ 12-02) Consolidated Application for Fuel Tax Refund Refund Period Beginning Refund Period Ending 2. Social Security # 3. Federal I.D. # (if applicable) 4. Taxpayer ID # (TID) 5. County A Section I: Information Section 1. Name or Business Name (Please Type or Print) Address City, State and Zip Code 6. License Type(s) (check box(es)) and # 7. Ownership Type (check one) A B C D Gasoline Distributor B Special Fuel Provider 8. Use of Fuel (check one) C License E F G H I # Sole Owner Partnership Commercial Corporation E F G H Federal Govt. State Govt. Municipal Govt. County Govt. I J Public Schools Other (Specify) A B C D Agriculture Aviation Building/Constr. Export Local Transit Systems J Railroad Maintenance Manufacturing K Refrigeration L Taxicabs Marine M Other (Specify) Mining Section II: Computation You may only use one gas tax rate, special fuel tax rate, and one sales tax rate per application. Type of Fuel 1. Beginning Inventory (Use Whole Gallons) 2. Purchases (Attach Invoices) 3. Total Available Gallons (Add Lines 1 and 2) 4. Gallons used for Taxable Purposes 5. Gallons used for Nontaxable Purposes (Gallons eligible for refund from Section III) 6. Ending Inventory (Subtract Lines 4 & 5 from Line 3) 7. Proportional Gallons Eligible for Refund (From Section VI) 8. Total Gallons Eligible for Refund (Add Lines 5 and 7) 9. Fuel Tax Rate (See Chart 1 for Rate) Enter the rate amount on Line 9A. 10. Amount of Fuel Tax Refund (Line 8 x Line 9) 11. Adjustment for Collection Allowance (if applicable) See Instructions 12. Enter Amount of Sales Tax Due (See Chart 2 for Rate) Enter the rate amount on Line 12A or 12B. 13. Enter Amount of Refund (Subtract Lines 11 & 12 from Line 10) * The term Gasoline includes Gasohol, see instructions. 1A 2A 3A 4A 5A 6A 7A 8A 9A 10A 11A 12A 13A Gasoline* Gals. 1B 2B 3B 4B 5B 6B 7B 8B 9B 10B Gasoline Does Not Qualify 11B 12B 13B Special Fuel Gals. .16 This application must be signed by the taxpayer or authorized agent before it will be accepted by the Department. (45 IAC 10-6-2). See Section VII: Signature/Authorization American LegalNet, Inc. www.FormsWorkflow.com Before a refund can be authorized - all applicable areas must be completed. Section III: Gasoline and/or Special Fuel Consuming Equipment List all fuel consuming equipment, including licensed vehicles, non-highway equipment and building construction equipment. Indicate the total gallons of fuel consumed by vehicle and/or equipment type, during the period for which the refund is claimed. Amount of gasoline and/or special fuel used. Type Make License Number Model Gasoline Gals. Gals. Gals. Gals. Gals. Gals. Gals. Carry To Section II Line 5A Special Fuel Gals. Gals. Gals. Gals. Gals. Gals. Gals. Carry To Section II Line 5B (Attach additional list if necessary.) Total Gallons Section IV: Gasoline and/or Special Fuel used in Agricultural Production (listed in Section III above.) Number of acres owned or rented for use by applicant Acres custom-farmed that are not owned or rented by the applicant Indicate the type of crops farmed, the acreage per crop and the total number of operations* performed for each crop listed (attach additional list if necessary). *Operations may include each time you: plow; disk; plant; cultivate; etc. Total Operations* for each Crop Gasoline Special Fuel Acres under cultivation Crop Crop Acreage List the number of gallons of gasoline or special fuel consumed in other farm operations, such as fuel used in the care of livestock, to grind feed, to pump water, etc. Gasoline Gals. Special Fuel Gals. Describe these uses in detail. Be certain to indicate the number and type of livestock. Section V: Motorboats and Other Exempt Uses (listed in Section III above.) If the tax paid gasoline and/or special fuel is used in a motorboat, indicate the river or lake on which the motorboat was operated. Other Exempt Uses (provide detailed explanation) American LegalNet, Inc. www.FormsWorkflow.com Section VI: Proportional Use Exemption Refund Only 1 Enter the Type of Vehicle (See instructions) 2 No. of Vehicles 3 Liability Period Beginning Date Ending Date 4 Eligible Miles Traveled 5 Eligible Gallons Consumed Use Whole Gallons 6 Exempt Percentage 7 Proportional Use Exempt Gallons Col. 5 x Col. 6 (see chart on page 3 of instructions) Gasoline Special Fuel When form is completed, please return to: Indiana Department of Revenue Compliance Division P. O. Box 1971 Indianapolis, IN 46206-1971 Section VII: Signature/Authorization Carry To Section II Line7A Carry To Section II Line 7B A. B. Total Gallons This application must be signed by the taxpayer or authorized agent before it will be accepted by the Department. (45 IAC 10-6-2). Applicant agrees, under penalty of perjury, that the information given on this form is, to the best of their knowledge, true, accurate, and complete. This form must be signed by an owner, partner, or corporate officer or by an authorized agent. If signed by authorized agent, a properly completed power of attorney must be attached to this form. Taxpayer or Authorized Agent Type or Print Title Date Signed Fax # E-mail Address Signature Phone # I authorize the Department to discuss my return with my tax preparer. Yes No Your Signature Date Paid Preparer's Name Address Federal I.D. Number, PTIN OR Social Security Number Preparer's daytime telephone number City State Zip Code + 4 Preparer's Signature Date American LegalNet, Inc. www.FormsWorkflow.com Form REF-1000 Instructions Who Should File This Form? Anyone who purchases undyed special fuel and/or gasoline, pays the Indiana special fuel and/or gasoline excise tax, and later uses the undyed special fuel and/or gasoline for an exempt (tax-free) purpose should file this form in order to get a refund of the fuel tax(es) paid. Per 45 IAC 12-1-7(1)(2), the definition of Gasoline includes Gasohol. Indiana Motor Carriers and IFTA Carriers must file for a refund on Form MCS-1789, Proportional Use Exemption Refund for Special Fuel Tax and Gasoline Tax. Reasons for a fuel tax refund include: * for agricultural purposes or operating off highway equipment * using special fuel for non-highway purpose (planes, trains, home heating) * operating as a common carrier of passengers including a taxicab (as defined in Indiana Code 6-6-1.1-103(1)) * operating an intercity bus as defined in Indiana Code 9-13-2-83 * operating a public transportation vehicle or public transit system
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