Form Mg-Rf - Application For Government Motor Fuel Tax Refund - Utah State Tax Commission
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Utah State Tax Commission
MG-RF
Application For Government
TC -114M
Rev. 7/04
Motor Fuel Tax Refund
Telephone: (801) 297-2200 for assistance
(1-800-662-4335 outside Salt Lake City but inside Utah)
Name
Federal identification number
Mailing address
Filing period (Begin: mmyy End: mmyy)
Begin:
End:
City, State, ZIP code
Refund application may not be filed more often than on a quarterly basis.
Motor fuel
Number of
Invoice
Transaction
Vendor’s name and address
tax paid
GALLONS
number
date
1. Total gallons (add "Number of Gallons" column)
1
2. Total Motor Fuel Tax Paid (add "Motor fuel tax paid" column).
2
This is your TOTAL REFUND
I certify that I meet all the conditions to qualify for this refund. I have examined this refund application, including
any accompanying schedules, and certify that to the best of my knowledge it is true, correct and complete.
Print name of person signing this form
Title
Signed
Date signed
Telephone number
X
If you need an accommodation under the Americans with Disabilities Act, contact the Tax Commission at (801) 297-3811
(TDD (801) 297-2020). Please allow three working days for a response.
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Parent category: Financial