Form Gas-1200c - Motor Fuel Claim For Refund Qualified Power Takeoff Vehicles 2004 - North Carolina Department Of Revenue Page 2
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1
2
3Page 2
Legal Name (First 10 Characters)
FEIN or SSN
GAS-1200C
Web
7-04
Part 2. Interstate Operations Computation
Motor Fuel that
Motor Fuel that
includes N.C. Road Tax
(If operating only within North Carolina proceed to Line 14.)
includes N.C. Road Tax
,
,
9.
Total miles operated by qualified power takeoff vehicles during 2004
9.
.0
,
,
10. Total miles operated outside of N.C. by qualified power takeoff vehicles during 2004
10.
.0
11. Percentage of out-of-state qualified power takeoff vehicles operations
11.
0.
(Line 10 divided by Line 9)
12. Total gallons of motor fuel used in qualified power takeoff vehicles for all operations
,
,
12.
.0
(Enter amount here and on Part 3, Line 14)
13. Total gallons of motor fuel used in qualified power takeoff vehicles for operations outside
,
,
13.
of North Carolina (Multiply Line 11 by Line 12; enter amount here and on Part 3, Line 15)
.0
Part 3. Computation of Refund
,
,
14. Total motor fuel used to operate qualified power takeoff vehicles
14.
.0
,
,
15. Motor fuel used to operate qualified power takeoff vehicles traveling outside of North
15.
.0
Carolina (From Part 2, Line 13; enter zero if all vehicles operate only in N.C.)
16. Total motor fuel used to operate qualified power takeoff vehicles in North Carolina
,
,
16.
.0
(Line 14 minus Line 15)
17. Total gallons of N.C. tax-paid motor fuel purchased for qualified power takeoff vehicles
,
,
17.
.0
(Enter amount from Part 1, Line 6b)
18. Total gallons of N.C. tax-paid motor fuel subject to refund
,
,
(Enter the smaller of Line 16 or Line 17)
18.
.0
19. Total gallons of motor fuel used in qualified power takeoff vehicles for which a refund
,
,
is requested (Multiply Line 18 by 33.33% or 0.3333)
19.
.0
20. Total gallons of tax-paid motor fuel used in nonhighway equipment for which refund
,
,
20.
is requested(From Part 1, Line 5)
.0
21. Total gallons of tax-paid motor fuel for which a refund is requested
,
,
(Add Lines 19 and 20)
21.
.0
,
22. Refund due on tax-paid motor fuel used in power takeoff vehicles and nonhighway
22.
.
equipment (Multiply Line 21 by $0.2445)
23. Sales tax due on motor fuel used in power takeoff vehicles and nonhighway equipment
,
a. General nonhighway use
23a.
.
(Multiply Line 21 by $0.0696)
b. Manufacturers and Farmers (See instructions for certification)
,
23b.
.
(Multiply Line 21 by $0.0099)
24. Total Refund Due
,
$
24.
.
(Line 22 minus Lines 23a and 23b)
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