Form Mvf 31 - Motor Fuel Refund Permit Application Page 2

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MVF 31
Rev. 12/08
Page 2
Yes
No If no, you must state a statutory reason. Be specific.
11. Are you subject to sales tax?
You are required to maintain all records relating to fuel purchases and usage for a period of four years from the date of the
purchase of the fuel. This application will not be processed unless all lines are completed and the application is signed and
dated.
Federal Privacy Act Notice
Because we require you to provide us with a Social Secu-
minister this tax. Your failure to supply any information re-
rity number, the Federal Privacy Act of 1974 requires us to
quested on a tax form prescribed by the tax commissioner
inform you that providing us with your Social Security num-
may result in (i) the imposition of penalties for failing to file a
ber is mandatory. Ohio Revised Code sections 5703.05,
complete tax return or (ii) the denial of a license, if appli-
5703.057 and 5747.08 authorize us to request this informa-
cable.
tion. We need your Social Security number in order to ad-
I declare under penalties of perjury that this application (including any accompanying statements) has been examined by me
and to the best of knowledge is a true, correct and complete application
Signature
Title
Date
Return completed application to the: Ohio Department of Taxation
Motor Fuel Tax Refund Unit
P.O. Box 530
Columbus, OH 43216-0530.
Retain a copy of application. Direct any questions to (614) 466-3503 or fax (614) 752-8644.

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