F.o.t. Application 7/fuel Oil Tax Act/fuel Oil Refund Form
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1F.O.T. APPLICATION 7
FUEL OIL TAX ACT
FUEL OIL USER REFUND
Permit # _______________________
Name ___________________________________________________________________________________________
Address _________________________________________________________________________________________
Phone ______________________ Fax ______________________ E-mail __________________________________
APPLICATION FOR REFUND OF FUEL UNDER A PERMANENT FUEL USER PERMIT
Instructions
1. Where there is an overpurchase of Yukon fuel, proof that tax was paid to another jurisdiction must be
provided.
2. Fuel transfer will be considered to bordering jurisdictions only. These include British Columbia, Alberta,
the Northwest Territories and Alaska, USA.
3. To prove tax payment, copies of bordering jurisdictions (IFTA, NWT) returns and cancelled cheques
must be provided. Proof of Alaska purchases must also be provided if applicable.
4. Refunds may be applied for once the litre credit has reached 5,000 litres, or after December 31.
5. Credits are not carried from year to year.
6. Refunds should be forwarded by December 31 the following year.
7. Refund applications will be considered only when account is in good standing.
Month ending
Litre credit
STATEMENT OF YUKON FUEL CONSUMPTION
Type of fuel
DIESEL
GASOLINE
Tax rate: $0.072
Tax rate: $0.062
TOTAL CREDIT
(step 7 of last return)
Multiply by tax rate
$
$
TAX REFUND CLAIM
I, __________________________________________, ______________________________ as a duly authorized
print title
print name
officer of ____________________________________________________________________________________
print company name
hereby CERTIFY that I have not made a previous claim, nor received refund of tax, on the above mentioned fuel, nor
any part thereof and that all statements on this claim are true and correct to the best of my knowledge.
Signature
Date
Mail this return to:
Deputy Head, Department of Finance, Government of Yukon
Box 2703, Whitehorse, Yukon Y1A 2C6
phone (867) 667-5345, fax (867) 456-6709
The personal information requested on this form is collected under the authority of and used for the purpose of administering the Fuel Oil Tax Act.
Questions about the collection or use of this information can be directed to the Yukon Department of Finance, Box 2703, Whitehorse, Yukon, Y1A 2C6,
(867) 667-5343.
Publié aussi en français
YG(1787QE)F1 Rev. 01/2013
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