Form 80-005 - Iowa Motor Fuel Tax Refund Permit Application Form - 2005 Page 2
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1
2Section IV Instructions and Definitions
VI. OWNERS, GENERAL PARTNERS, CORPORATE
(21) Agricultural Production: Farmers, ranchers, greenhouses and other
OFFICERS AND RESPONSIBLE PARTIES
similar businesses using motor fuel or undyed special fuel in agricultural or
livestock production.
Print the names and Social Security Numbers of all. Attach additional
(31) Federal Government: The United States, its agencies and instrumentalities.
sheets if necessary.
This includes the Red Cross, Project Head Start, Federal Land Banks, Federal
Land Bank Associations.
Name: _______________________________________________
(32) State Government: The State of Iowa, its agencies and political subdivisions.
(33) Other Political Subdivisions: An entity that (a) has a specific geographic
SSN: ________________________________________________
area, and (b) has public officials elected at public elections, and (c) has taxing
power, and (d) benefits the general public, and (e) is approved by the State of
Name: _______________________________________________
Iowa. This includes counties, cities, and schools.
(34) Urban Transit System: Bus systems that transport passengers without
SSN: ________________________________________________
discrimination primarily on the streets of cities and meet the requirements of the
Iowa Department of Transportation.
Name: _______________________________________________
(35) Regional Transit System: A public transit system serving one county or
all or part of a multi-county area whose boundaries correspond to the regional
SSN: ________________________________________________
planning areas designated by the governor or approved by the Iowa Department
of Revenue.
Name: _______________________________________________
(36) Native American Tribe: Native American Tribes who purchase and use
fuel for tribal purposes on their own Indian Country and/or Native American
SSN: ________________________________________________
Tribes who sell directly to their tribal members on their own Indian Country.
(41) Contract Carrier: A carrier who has a contract with a public school under
VII. DIRECT DEPOSIT OF REFUNDS
Iowa Code section 285.5 for transporting students.
(51) Commercial Fishing: Licensed and operating under an owner’s certificate
Do you wish to have your refund deposited directly into your bank
issued pursuant to Iowa Code section 482.4; for fuel used in watercraft.
account?
(52) Home Heating: Motor fuel or undyed special fuel used in home heating.
No
(53) Extraction and Processing of Natural Deposits: Motor fuel or undyed
special fuel used for extraction and processing of natural deposits.
Yes
Complete the enclosed form 90-303.
(54) Denaturing Alcohol: Motor fuel or undyed special fuel used for denaturing
alcohol.
(60) Commercial
VIII. CURRENT/PRIOR BUSINESS ACTIVITY
Refrigeration Units (reefers): Motor fuel and undyed special fuel.
Pumping Credits (dry products): Motor fuel or undyed special fuel placed in
Do you currently operate a business at another location in Iowa?
the supply tank of a motor vehicle when the motor is used as a power source for
Yes
No
If yes, complete the following:
off-loading.
Pumping Credits (wet products): Motor fuel or undyed special fuel placed in
Fuel Tax Refund Permit No.: _____________________________
the supply tank of a motor vehicle when the motor is used as a power source for
off-loading.
Sales Tax Permit No.: ___________________________________
Off Road: Motor fuel and undyed special fuel in unlicensed vehicles not
Fuel Tax License No.: __________________________________
operated on public highways.
Export of Tax Paid Fuel: Distributors only. Motor fuel or undyed special fuel
Withholding FEIN No.: _________________________________
purchased tax-paid and sold in smaller quantities (less than transport load) to
consumers outside the state.
If you are purchasing this business, give the previous owner’s name:
Idle Time: Motor fuel or undyed special fuel used when the engine is running
____________________________________________________
but not propelling the vehicle. Contact the Iowa Department of Revenue and
explain how the percent of idle time is calculated.
IOWA COUNTIES AND COUNTY NUMBERS
Power Takeoff: Motor fuel or undyed special fuel used for powering auxiliary
26-DAVIS
51-JEFFERSON
76-POCAHONTAS
equipment that is powered by the power takeoff.
01-ADAIR
02-ADAMS
27-DECATUR
52-JOHNSON
77-POLK
Ready Mix: Motor fuel or undyed special fuel placed in the fuel supply tank of
03-ALLAMAKEE
28-DELAWARE
53-JONES
78-POTTAWATTAMIE
the vehicle; refund on 30 percent; accurate records must be maintained.
04-APPANOOSE
29-DES MOINES
54-KEOKUK
79-POWESHIEK
30-DICKINSON
55-KOSSUTH
80-RINGGOLD
05-AUDUBON
Solid Waste: Off-loading. Motor fuel or undyed special fuel placed in the fuel
31-DUBUQUE
56-LEE
81-SAC
06-BENTON
supply tank of the vehicle; refund on 30 percent; accurate records must be
07-BLACK HAWK
32-EMMET
57-LINN
82-SCOTT
maintained.
33-FAYETTE
58-LOUISA
83-SHELBY
08-BOONE
34-FLOYD
59-LUCAS
84-SIOUX
09-BREMER
(70) Refund Agent: A person requesting a refund for idle time, power take-off,
10-BUCHANAN
35-FRANKLIN
60-LYON
85-STORY
refrigeration units, pumping credits, or transport diversions may designate
11-BUENA VISTA
36-FREMONT
61-MADISON
86-TAMA
another person as an agent to file the claim and receive the refund. See the
12-BUTLER
37-GREENE
62-MAHASKA
87-TAYLOR
previous definitions for the following: Reefer Unit, Pumping Credits (dry
38-GRUNDY
63-MARION
88-UNION
13-CALHOUN
14-CARROLL
39-GUTHRIE
64-MARSHALL
89-VAN BUREN
products), Pumping Credits (wet products), Idle Time, Power Takeoff. Complete
15-CASS
40-HAMILTON
65-MILLS
90-WAPELLO
form 80-015.
41-HANCOCK
66-MITCHELL
91-WARREN
16-CEDAR
Incomplete applications delay processing.
42-HARDIN
67-MONONA
92-WASHINGTON
17-CERRO GORDO
18-CHEROKEE
43-HARRISON
68-MONROE
93-WAYNE
19-CHICKASAW
44-HENRY
69-MONTGOMERY
94-WEBSTER
FOR ASSISTANCE, CALL...
45-HOWARD
70-MUSCATINE
95-WINNEBAGO
20-CLARKE
1-800-367-3388 (Iowa, Omaha, Rock Island/Moline)
46-HUMBOLDT
71-O’BRIEN
96-WINNESHIEK
21-CLAY
22-CLAYTON
47-IDA
72-OSCEOLA
97-WOODBURY
515/281-3114 (local, out of state)
23-CLINTON
48-IOWA
73-PAGE
98-WORTH
24-CRAWFORD
49-JACKSON
74-PALO ALTO
99-WRIGHT
E-mail: idr@iowa.gov
80-005 (9/13/05)
25-DALLAS
50-JASPER
75-PLYMOUTH
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