Form Mvf-81 - Ohio Motor Fuel Tax Refund Claim For School Districts

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MVF-81
Rev. 8/05
P.O. Box 530
Columbus, OH 43216-0530
Ohio Motor Fuel Tax Refund Claim for School Districts
Period
to
(must be filed within 365 days)
Permit number
Name
Address
City
State
ZIP
1. Total gallons of tax-paid motor vehicle fuel purchased during the period (see instructions) ......
2. Total gallons of tax-paid motor vehicle fuel sold to others during the period ..............................
3. Total gallons of tax-paid motor vehicle fuel purchased for school district or Educational
Service Center operations (line 1 minus line 2) ..........................................................................
4. Total refund requested (line 3 multiplied by tax rate
– see instructions) ........................ $
I declare under penalties of perjury that this claim (including any accompanying schedules and statements) has been
examined by me and to the best of my knowledge and belief is true, correct and complete.
Signature
Title
Telephone
Date
The original claim should be submitted to the Ohio Department of Taxation, Motor Fuel Tax Refund Unit, P.O. Box 530,
Columbus, Ohio 43216-0530. Contact the Motor Fuel Tax Refund Unit at (614) 466-3503 with any questions or go to our
website (tax.ohio.gov). Claimant must retain a copy of this claim and all pertinent supporting documents.
Instructions
Note: No refund shall be authorized under Ohio Revised
number of gallons purchased and the purchase price,
Code Section 5735.142 for any single refund claim for
must be submitted with this claim.
less than 100 gallons.
Line 2 Fuel sold to others: Enter the total number of gallons
Period covered by the claim: Enter both the beginning
of tax-paid motor vehicle fuel (included in line 1) that
and ending dates covered by this claim. The claim must be
was sold from bulk storage to others.
filed within 365 days from the date of fuel purchase.
Line 3 Total refundable gallons purchased: Line 1 minus
Line 1 Fuel purchased: Enter the total number of gallons
line 2.
of tax-paid motor vehicle fuel purchased for school
Line 4 Refund: Enter the net amount of this claim, which is
district or Educational Service Center operations
line 3 multiplied by the refundable rate per gallon as
during the period covered by this claim. Evidence of
shown below:
fuel purchase, such as fuel invoices, cash receipts,
credit card receipts or any other document that
July 1, 2003 to June 30, 2004
$0.02
contains the name and address of the seller, name of
July 1, 2004 to June 30, 2005
$0.04
the purchaser, date of purchase, type of fuel, the
July 1, 2005 and after
$0.06

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