Form Au-738 - Motor Vehiclesfuels Tax Refund Claim - Nutrition Program - 2006
Download a blank fillable Form Au-738 - Motor Vehiclesfuels Tax Refund Claim - Nutrition Program - 2006 in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Form Au-738 - Motor Vehiclesfuels Tax Refund Claim - Nutrition Program - 2006 with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2Department of Revenue Services
Form AU-738
Reset Form
Excise Taxes Unit
Fuel Type
Motor Vehicle Fuels Tax Refund Claim
25 Sigourney Street
Diesel
Motor Vehicle Fuels
(Gasoline - Gasohol)
Hartford CT 06106-5032
Nutrition Program
You must check the appropriate fuel type on the right. Refund claims must
Claim Type
(Rev. 07/06)
be filed on or before May 31, 2007, for fuel used during calendar year 2006.
Nutrition Program
Complete this refund claim in blue or black ink only.
Name of Claimant (Type or print)
Period of Claim in Calendar Year
2006
For DRS Use Only
Audit Number
____/____ through ____/____
Claim Number
Voucher Number
Telephone Number
CT Tax Registration Number
(
)
Refund Gallons
Number and Street
FEIN
City or Town
SSN
Net Refund
$
State
ZIP+4
Due On or Before
Reviewed By
Date
May 31, 2007
Type of Business
Location of Records (if different from above)
Approved By
Date
Schedule A
Statement of Motor Vehicle Fuel Purchases. Receipts must be attached.
Date
Name of Supplier
Gallons of Fuel
Date
Name of Supplier
Gallons of Fuel
Total
(Round to the nearest whole gallon.)
You must attach a copy of your contract with your local area agency on aging as evidence of your eligibility to provide
Title III-C meals to senior citizens.
Schedule B
Computation of net refund.
1.
Total miles for period
1.
2.
Total fuel gallons for period (Enter the total number gallons of fuel from Schedule A.)
2.
3.
Average miles per gallon (Divide Line 1 by Line 2.)
3.
4.
Total miles in delivery vehicles that are used exclusively for the delivery of meals to senior citizens
4.
5.
Refund gallons (Divide Line 4 by Line 3.)
5.
Tax refund claimed
.00
(Multiply Line 5 by _____ per gallon. (See refund rate table on reverse side for appropriate rate.))
6.
6. $
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 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
Print Taxpayer Name
Telephone Number
Date
Print Preparer Name
Preparer’s Address
Preparer’s SSN or PTIN
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Financial