Form Sfr-1032 - Application For Special Fuel Tax Refund
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1
2INDIANA REVENUE FORM
INDIANA DEPARTMENT OF REVENUE
SFR-1032
APPLICATION FOR
SPECIAL FUEL TAX REFUND
Rev. 03/00
(This application includes only diesel fuel and heating oil)
State Form 46296
SECTION I: INFORMATION SECTION
NAME (Please Type or Print)
SOCIAL SECURITY NUMBER
ADDRESS
FEDERAL I.D. NUMBER (if applicable)
CITY OR TOWN, STATE AND ZIP CODE
COUNTY
G
A.
DO YOUR SUPPORTING INVOICE(S) INCLUDE A PROPORTIONAL USE
C. USE OF SPECIAL FUEL
TRANSPORTATION SYSTEMS
G
G
REFUND CLAIM?_____
IF YES, ATTACH YOUR COMPLETED MF-6431.
(INCLUDING
AGRICULTURAL
AVIATION
G
B.
TYPE OF OWNERSHIP:
implements of Husbandry)
MARINE
G
G
G
G
MINING
RAILROAD
COMMERCIAL
COUNTY GOVERNMENT
G
G
MANUFACTURING & OTHER INDUSTRIAL
HOME HEATING
G
G
G
PRIVATE
PUBLIC SCHOOL
G
BUILDING AND CONSTRUCTION
TAXICABS
G
G
G
G
FEDERAL GOVERNMENT
MUNICIPAL
EXPORT
MAINTENANCE
G
G
G
REFRIGERATION UNIT
STATE GOVERNMENT
OTHER (Please Specify)
G
OTHER (Please specify)
SECTION II: COMPUTATION OF SPECIAL FUEL TAX REFUND
For period beginning ___/___/___ and ending ___/___/___.
NOTE: All appropriate schedules on reverse side of application must be completed before computing your special fuel tax refund.
1. Enter the total gallons of special fuel purchased (per attached original invoices or copies certified on
Form REF1000A)..........................................................................................................................................................
1.
Gals.
2. Enter the total gallons of special fuel placed into licensed vehicles. Also, include any other gallons not
eligible for refund. (Do not include special fuel placed into taxicabs or local transit system buses or
2.
Gals.
implements of husbandry as decribed in the instructions)...................................................................................
3. Enter total gallons eligible for refund (Line 1 minus Line 2)..................................................................................
3.
Gals.
4. $
4. Enter the total amount of special fuel tax refund (Multiply Line 3 by $.16)........................................................
IF THE REQUIRED INFORMATION IS NOT COMPLETED ON THIS FORM, THE APPLICANT MAY EXPERIENCE DELAYS
IN THE PROCESSING OF THE REFUND.
ALL INVOICES AND ANY SUPPLEMENTAL SHEETS MUST BE ATTACHED TO THIS FORM.
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 an authorized
agent, a properly completed power of attorney must be attached to this form.
Taxpayer or Authorized Agent
Typed or Printed Name
Title
Date Signed
Telephone Number
(
)
WHEN FORM SFR-1032 IS COMPLETED, PLEASE RETURN TO:
INDIANA DEPARTMENT OF REVENUE
COMPLIANCE DIVISION
TRUST/REFUND SECTION
P.O. BOX 1971
INDIANAPOLIS, IN 46206-1971
(317) 232 - 0073
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