Indiana > Statewide > Department Of Revenue > Motor Carrier
Claim For Proportional Use Credit MCS-1789 - Indiana
| Claim For Proportional Use Credit Form. This is a Indiana form and can be used in Motor Carrier Department Of Revenue Statewide . |
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MCS-1789 State Form 49868 (R2 / 3-13) Indiana Department Of Revenue Motor Carrier Services Division Departmental Use Only Total Gallons Total Miles _______________ _______________ Claim For Proportional Use Credit Quarter ________ Year _________ Indiana Amount Paid _______________ Total Amount Paid _______________ Claimant's Name Indiana TID Number Non-Indiana Based IFTA Number Interstate or Indiana US DOT Number Complete This Section Only If Changing Address Or Telephone Number. Street Address City State Zip Telephone Number You Must Submit With This Claim For Credit · MCFT-101/IFTA-101 or · Out of State Return Please refer to instructions before proceeding. Attach additional sheets if necessary. 1 Vehicle Type Codes (See Instructions) 2 Number of Vehicles 3 Eligible Miles Traveled 4 Eligible Gallons Consumed (Use Whole Gallons) 5 Exempt Percentage (See Instructions) 6 Proportional Use Exempt Gallons Col.4 x Col.5 (Use Whole Gallons) 7 Tax Rate 8 Refund Claimed Col. 6 x Col.7 % % % % % % % % .27 $ .27 $ .27 $ .27 $ .27 $ .27 $ .27 $ .27 $ Total Refund Due $ Applicant agrees, under penalty of perjury, that the information given on this form is, to the best of their knowledge, true, accurate, and complete. The applicant further attests that the attached quarterly tax return is a true and accurate copy of the return filed with the based jurisdiction. This form must be signed by an owner, partners, or a corporate officer or by an authorized agent. If signed by an authorized agent, a properly completed power of attorney must be enclosed with this form. Mail the completed form to the Indiana Department of Revenue with your quarterly return. Signature of Taxpayer or Authorized Agent Typed or Printed Name Title Date Signed Telephone Number American LegalNet, Inc. www.FormsWorkFlow.com Claim for Proportional Use Credit Information and Instructions The claim for credit must be completed only by companies, sole proprietorships, partnerships, or other legal entities that have been previously certified by the department and that are seeking a refund of taxes paid on motor fuel consumed in a motor vehicle which has a common fuel reservoir used to propel the motor vehicle along the highway and for some other commercial purpose. Column 1: Enter the vehicle type code. (shown on last page) Column 2: Enter the number of vehicles listed in column 1. The number of vehicles listed here must match the number on the certification approved by the department. Vehicle additions and/or deletions must be indicated on this form in the Vehicle Add and/or Delete Section found on page 2. Only the certification vehicle(s) and the vehicle(s) added in the appropriate area will be considered for the claim. Column 3: Enter the total number of eligible miles traveled in the state of Indiana by the vehicle(s) shown in Column 1 for the quarterly tax reporting period. Column 4: Enter the total number of eligible whole gallons consumed in Indiana by the vehicle(s) shown in Column 1 for the quarterly tax reporting period. Column 5: Enter the exempt percentage (indicated on the list of percentages) by vehicle(s) type in Column 1. Column 6: Enter the proportional use exempt gallons by multiplying Column 4 by Column 5. Column 7: The tax rate is .27. Column 8: To calculate your possible refund amount, multiply Column 6 by Column 7. Motor Carrier Fuel Tax and Surcharge Tax To receive a proportional use exemption credit for motor carrier fuel and surcharge tax, you must submit your quarterly return with the proper payment. Filing your quarterly returns late (the due date is shown on the quarterly return) or failing to submit your quarterly return (MCFT-101 or IFTA-101) with payment will result in denial of your claim for credit. **Non-Indiana Carriers** If you submit your quarterly tax return to a state/jurisdiction other than Indiana, you must submit a copy of that quarterly report with your Claim for Proportional Use Credit form. No claim for credit forms can be processed without the quarterly tax return for the tax quarter in which the proportional claims are being made. The department may require that any person, licensed or unlicensed, provide any additional proof that the department deems necessary. Failure to provide verification will result in the denial of the claim. If you operate a type of vehicle for which a proportional use credit should be allowed and it is not listed or is listed and you have proof that the vehicle is entitled to a different percentage than indicated on the chart, please contact our office at (317) 615-7345 for assistance in determining the allowable percentage. Indiana Department of Revenue Motor Carrier Services Division P.O. Box 6078 Indianapolis, IN 46241-6078 American LegalNet, Inc. www.FormsWorkFlow.com Code 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 Air Conditioning Unit for Bus10% .................................................10% Bookmobile...................................................................................35% Boom Truck-Block Boom ..............................................................20% Bulk Feed Truck ...........................................................................15% Car Carrier with Hydraulic Winch .................................................10% Carpet Cleaning Van ....................................................................15% Cement Mixer ...............................................................................30% Distribution Truck-Hot Asphalt ......................................................10% Dump Trailer .................................................................................15% Dump Truck ..................................................................................23% Fire Truck .....................................................................................48% Leaf Truck.....................................................................................20% Lime Spreader ..............................................................................15% Line Truck-Digger/Derrick, Aerial Lift Truck ..................................20% Milk Tank Truck .............................................................................30% Mobile Crane ................................................................................42% Pneumatic Tank Truck ..................................................................15% Refrigeration Truck ..................................................
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