Form Au-738 - Motor Vehicle Fuels Tax Refund Claim - Nutrition Program

Instructions

Your motor vehicle fuels tax refund claim for fuel used during

calendar year 2004 must:

Table of Motor Vehicle Fuels Tax Refund Rates for 2004

Be filed with Department of Revenue Services (DRS) on or

for Nutrition Program

before May 31, 2005; and

Involve at least 200 gallons of fuel eligible for tax

Diesel

26¢ per Gallon

January 1, 2004 through December 31, 2004

refund.

Motor Vehicle Fuels

The appropriate fuel type box must be marked on the front of

24¢ per Gallon

this form in order to process this claim. You must file a separate

January 1, 2004 through June 30, 2004

Form AU-738 for each motor vehicle fuel type.

25¢ per Gallon

July 1, 2004

through December 31, 2004

Note: You must file a separate Form AU-738 for each motor

Be sure to provide a telephone number where you can be

vehicle fuel type.

contacted.

You must indicate your Connecticut tax registration number or

available to DRS upon request.

Social Security Number in the space provided.

For all purchases of fuel listed, you must attach a copy of each

Rounding Off to Whole Dollars:

You must round off cents to the

numbered slip or invoice issued at the time of the purchase. The

nearest whole dollar on your motor vehicle fuels tax refund claim.

slip or invoice may be the original or a photocopy and must show

Round down to the next lowest dollar all amounts that include 1

the:

through 49 cents. Round up to the next highest dollar all amounts

that include 50 through 99 cents. However, if you need to add

•

Date of purchase;

two or more amounts to compute the total to enter on a line,

•

Name and address of the seller (which must be printed or

include cents and round off only the total.

rubber stamped on the slip or invoice);

Example: Add two amounts ($1.29 + $3.21) to compute the total

•

Name and address of the purchaser (which must be the

($4.50) to enter on a line. $4.50 is rounded to $5.00 and entered

name and address of the person or entity filing the claim for

on the line.

refund);

You must attach a copy of your contract with your local area

•

Number of gallons of fuel purchased;

agency on aging as evidence of your eligibility to provide

•

Price per gallon;

Title III-C meals to senior citizens.

•

Total amount paid; and

Mail the completed refund application to:

Department of Revenue Services

•

If payment is made within a discounted period, provide proof

State of Connecticut

of amount paid.

Excise Taxes Unit

You must retain records to substantiate your refund claim for at

25 Sigourney Street

least three years following the filing of the claim and make them

Hartford CT 06106-5032

Additional Information

If you need additional information or assistance, please call the

Excise Taxes Unit at 860-541-3224, Monday through Friday, 8:00

a.m. to 5:00 p.m. Forms may be downloaded from our Web site at

Your refund will be applied against any outstanding

DRS tax liability.

Form AU-738 Back (Rev. 01/05)

Form Au-738 - Motor Vehicle Fuels Tax Refund Claim - Nutrition Program - 2004 Page 2

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