Form Dr 7121 - Aviation Tax Refund Claim - 1997
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1DR 7121 (12/97)
DO NOT WRITE IN SHADED AREA
COLORADO DEPARTMENT OF REVENUE
AVIATION TAX
MOTOR CARRIER SERVICES DIVISION
VALIDATION NUMBER
1375 SHERMAN STREET
REFUND CLAIM
DENVER CO 80261-0016
(303) 232-2451
Y -
TIME LIMIT DATE
AUDIT DATE
j u l
# OF INVOICES
EARLIEST DATE
LATEST DATE
AR
DELETE
Colorado Permit / Account Number
Refund Period
FEIN or Social Security Number
j u l
FUEL TAX REFUND CALCULATIONS
AUD. DED.
A. AVIATION GASOLINE B. AVIATION JET FUEL
1. Amount of Colorado Fuel Tax Paid (per gallon).
Note: This amount must be shown on your attached invoices.
2. Amount of Colorado Fuel Tax Due (per gallon).
Colorado Aviation Fuel Tax Rate Schedule
Aviation Gasoline - used for the propulsion of nonturbo-propeller or nonjet engine aircraft
.06/gal
Aviation Jet Fuel - used for the propulsion of turbo-propeller or jet engine aircraft
.04/gal
Aviation Gasoline - used solely and exclusively by state licensed agricultural applicator aircraft for agricultural applications
.03/gal
Aviation Jet Fuel - used solely and exclusively by state licensed agricultural applicator aircraft for agricultural applications
.02/gal
3. Amount of Colorado Fuel Tax to be refunded (per gallon) (line 1
less line 2). Enter this amount on line 8.
4. Total number of gallons of fuel purchased as shown on invoices.
K
Please make sure that the purchase date on the invoice(s) is not more
than 6 months old from the date this claim is mailed.
K
5. Deduct number of gallons of fuel sold or used for taxable
aviation purposes.
K
6. AUD. DED.
7. Net number of gallons of fuel used in Colorado for which
refund is claimed (line 4 less line 5).
8. Enter amount of Colorado Fuel Tax to be refunded per gallon
K
from line 3 for each fuel type.
9. Amount of claim on fuel. (Number of gallons on line 7 multiplied
K
by line 8.)
10. Total amount of claim (add together lines 9A and 9B).
$
11. Total bulk storage available for________gallons.
12. If fuel was used for custom work, give name and address of persons for whom you worked on a supplemental sheet and attach it to this claim.
13. List below any newly added equipment in which fuel was reported used (if additional space is needed use supplemental sheet):
Make and Type of Equipment
Serial and/or License #
Year
14. Enter the name and location of the airport where the fuel was used and the quantity used.
I certify and declare that this application is true and correct and that it is made under penalties of perjury in the second degree.
Name of Claimant, Corporation or Partnership
Signature of Claimant
Signature of Witness
Date
Telephone
SEE REVERSE SIDE FOR INSTRUCTIONS ON COMPLETING THIS FORM
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