Form Au-550 - Application For Credit For Reduced Rate Petroleum Products printable pdf download

STATE OF CONNECTICUT

DEPARTMENT OF REVENUE SERVICES

PETROLEUM PRODUCTS GROSS EARNINGS TAX

FORM

FORM A A A A A U-550

U-550

(Rev. 11/00)

APPLICA

APPLICATION FOR CREDIT FOR REDUCED RA

TION FOR CREDIT FOR REDUCED RA

TION FOR CREDIT FOR REDUCED RATE PETR

TE PETR

TE PETROLEUM PR

OLEUM PR

OLEUM PRODUCTS

ODUCTS

APPLICA

TION FOR CREDIT FOR REDUCED RA

TE PETR

OLEUM PR

ODUCTS

Name of Company Using Reduced Rate Petroleum Products

Address

City or Town

State

ZIP Code

Name of Seller

Date of Purchase

REDUCED RATE PETROLEUM PRODUCTS CERTIFICATION

This certifies that we have used the reduced rate petroleum products listed below, in the quantities shown. These petroleum products were purchased in the

State of Connecticut and the 5% gross earnings tax was paid on the purchase price. It is requested that credit in the amount of $______________ be issued to

the purchaser because the petroleum products were ultimately used in a reduced rate manner.

For petroleum products gross earnings tax purposes, the following products are reduced rate petroleum products: Number 6 oil used exclusively by a company

that is included in code classifications 2000 through 3999, inclusive, of the Standard Industrial Classification (SIC) Manual, 1987 edition, or in Sector 31, 32 or 33

of the North American Industrial Classification Systems (NAICS) United States Manual, United States Office of Management and Budget, 1997 edition; and Number

2 heating oil used exclusively in a vessel that is primarily engaged in interstate commerce, where the vessel qualifies for an exemption from sales and use taxes

under Conn. Gen. Stat. §12-412, as amended.

Date of

Gross Earnings

Purchase

Type of Reduced Rate Petroleum Product

Gallons

Purchase Price

Tax Paid

1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 1 2 3 4 5

9. Total Gross Earnings Tax Paid

1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 1 2 3 4 5

(Total of Column D)

1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 1 2 3 4 5

10. Multiply Line 9 by .60 (60%)

X .60

1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 1 2 3 4 5

11. Total Amount of Credit Due

1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 1 2 3 4 5

I declare under the penalty of false statement that I have examined this application, FORM AU-550, and to the best of my knowledge and belief it is true,

complete, and correct. (The penalty for false statement is imprisonment not to exceed one year or a fine not to exceed two thousand dollars, or both.)

Signed

Title

Date

ORIGINAL PURCHASER ENDORSEMENT (IF DIFFERENT THAN FIRST SELLER)

To (Name of Seller): ___________________________________________________________________________________________

Based on the information shown above, a credit in the amount of

$ _______________ has been made to ___________________________________________________________________________ .

(Name and Address)

We hereby request credit in the amount of $ ______________________ .

_____________________________________________________________________________________________________________

Name of Original Purchaser

Signed