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INSTRUCTIONS FOR COMPLETING THE PENNSYLVANIA MOTOR FUELS TAX

REIMBURSEMENT CLAIM FORM FOR UNDYED DIESEL AND UNDYED KEROSENE

USED EXCLUSIVELY IN TRUCK REFRIGERATION UNITS

GENERAL INSTRUCTIONS AND INFORMATION

Section 9017(e.1) of the Liquid Fuels and Fuels Tax, as amended, provides for a reimbursement of Motor Fuel Taxes paid on undyed

diesel and undyed kerosene used in truck refrigeration units. To be eligible for the reimbursement: (1) individual fuel purchases and

invoices must be in quantities of 75 gallons or less for each fueling; (2) the fuel must be placed into a separate supply tank connected

only to a truck mounted refrigeration unit (fuel placed into the tank used to supply fuel for the vehicle's engine is not eligible for

reimbursement); (3) carriers must submit a reimbursement claim form (postmarked) on or before the 60th day following the end of each

calendar quarter; and (4) carriers must maintain records relative to such fuel purchases for a period of three years following the

submission of a claim. Fuel purchase documentation, such as invoices, must show the vendor's name and address, date of purchase,

type fuel, gallons purchased, total cost, vehicle unit number, the purchaser's name, and that the fuel was "reefer fuel”. In cases where

fuel is dispensed from the carrier's own bulk storage into a supply tank used exclusively for truck refrigeration, the carrier must main-

tain records similar to the above to substantiate that the bulk-fuel purchases were used in truck refrigeration and that tax was paid

on the fuel purchased in PA for which tax reimbursement is sought.

The Department may require a claimant to satisfy any Sales/Use Tax liability on the undyed diesel/kerosene for which the reimbursement

is claimed. Use Tax is the 6% tax on the use of tangible personal property (undyed diesel/kerosene) or services when Sales Tax has

not been paid. An additional 1% local sales or use tax applies if the undyed diesel/kerosene was purchased in Philadelphia or Allegheny

county. Use Tax should be calculated on the net purchase price (purchase price less tax received as a refund) of the gallons for which

a carrier has received a refund and then remitted to the Commonwealth electronically via e-TIDES or TeleFile, unless the carrier’s use

of the fuel qualifies for a Sales/Use Tax business exemption. Questions regarding PA Sales/Use Tax on undyed diesel/kerosene should

be directed to (717) 772-2960.

Records as described above must be maintained for a period of three years following the submission of a reimbursement claim. Carriers

failing to maintain records as described above may have their reimbursement claims denied, and in the event a claim has already been

paid, the refund may be assessed as a chargeback.

False claims, upon prosecution, are misdemeanors of the third degree pursuant to Section 9018 of the Liquid Fuels and Fuels Tax Act.

LINE INSTRUCTIONS

Section A.

Questions 1 through 6 – Show general information regarding the claimant.

Question 7 – Show the number of truck refrigeration units included in the claim.

Question 8 – Show the year and quarter for which reimbursement is requested.

Question 9 – Show your PA Sales/Use Tax License Number. Indicate N/R if no license exists.

Section B.

Question 1 – Show the gallons of undyed diesel or undyed kerosene used exclusively in truck refrigeration units by month. [ Note:

Carriers must submit copies of source documentation (fuel purchase invoices) for one month of the claim or as

otherwise directed by the Department.]

Question 2 – Show the total gallons claimed for the quarter for which reimbursement is requested.

Question 3 – Calculate the reimbursement amount using the rate table below.

Section C.

Sign the certification indicating that the claimant has not directly or indirectly received a refund or credit of the tax for which

reimbursement is being claimed, and that the claim is true, complete and correct. Claim forms must be filed (postmarked) as

described under the General Instructions and Information section above. Submit the claim to the:

PA Dept. of Revenue, Bureau of Motor Fuel Taxes, PO BOX 280646, Harrisburg, PA 17128-0646.

REIMBURSEMENT RATE TABLE

Use this table to calculate the amount of your reimbursement in Section B, Line 3 on the front of this form.

YEAR

TAX RATE/GALLON

2002

$ .318

2003

$ .308

2004

$ .312

2005

$ .364

2006

$ .381

2007

$ .381

2008

$ .381

DO NOT SUBMIT THE CLAIM WITH YOUR QUARTERLY IFTA TAX REPORT/SCHEDULE. Claims filed late will

be denied. Any claim denied may be appealed to the Department of Revenue, Board of Appeals, PO BOX 281021, Harrisburg, PA

17128-1021 or at Petitions must be filed within 90 days of the date of the denial.

Questions regarding Truck Refrigeration Reimbursements should be addressed to the Bureau of Motor Fuel

Taxes at the address shown on the front of this form, or by telephone, (717) 783-9362.

Form Rev-643 Mf - Motor Fuels Tax Reimbursement Claim Form For Undyed Diesel And Undyed Kerosene Used In Truck Refrigeration Units Page 2

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