Instructions For Form Au-630 - Application For Reimbursement Of The Petroleum Business Tax - New York State Department Of Taxation And Finance Page 2
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2AU-630-I (4/01) (back)
For sales of fuel to customers, you must also produce copies of
Residual petroleum product section
your sales invoices showing that the tax was not passed through to
Line 13 — Enter the total number of gallons from Schedule D,
your customers.
column f.
General instructions
Line 14 — Enter the rate per gallon of petroleum business tax that
you paid on the residual petroleum product to your supplier. If
Enter your employer identification number or social security
you paid more than one rate of petroleum business tax on the
number, your telephone number, the legal name of the business,
residual petroleum product, enter various on line 14, show the
the DBA (if different from the legal name), and the business
result of your computation on line 15 from a separate schedule,
address.
and attach the schedule to this form. Petroleum business tax rates
Part I — Basis for reimbursement
are listed in Publication 908, Fuel Tax Rates .
Check one or more boxes to indicate the basis for the
Line 15 — Multiply the total number of gallons on line 13 by the tax
reimbursement and, if applicable, check the box(es) to indicate the
rate on line 14. This is the amount of petroleum business tax on
type of fuel. Then complete the corresponding schedule in detail.
residual petroleum product to be reimbursed.
Schedule A — For sales of diesel motor fuel for residential
Total reimbursement section
heating.
Line 16 — Add lines 6, 12, and 15. This is the total amount of
Schedule B — For sales of motor fuel or diesel motor fuel to
reimbursement requested.
New York State, its agencies, instrumentalities, or political
subdivisions, or to the United States, its agencies or
Certification — This application for reimbursement must be
instrumentalities.
signed and dated by the owner (if an individual); a partner (if
partnership); or (if a corporation) by the president, treasurer, chief
Schedule C — For sales of motor fuel that was exported (delivered
accounting officer, or any other person authorized to act on behalf
outside of New York State).
of the corporation. The fact that an individual’s name is signed on
Schedule D — For claims based on your use of the fuel that is
the certification shall be prima facie evidence that the individual is
exempt or refundable under the Tax Law.
authorized to sign and certify the report on behalf of the business.
All schedules should list each transaction, indicating the date of
Attach the appropriate Power of Attorney form, if applicable.
sale or purchase, the purchaser’s or seller’s name and address,
Mail your completed application and supporting documents to:
federal/state contract or approval number, and the number of
NYS Tax Department, Fuel Tax Refund Unit, PO Box 5501,
gallons sold. Attach additional sheets, if necessary. Remember to
Albany NY 12205.
attach the documentary proof previously explained.
Part II — Computation of reimbursement
Private delivery services
If you choose, you may use a private delivery service, instead of
Line instructions
the U.S. Postal Service, to file your return. However, if, at a later
Diesel motor fuel section
date, you need to establish the date you filed your return, you
cannot use the date recorded by a private delivery service unless
Line 1 — Enter the total number of gallons from Schedule A,
you used a delivery service that has been designated by the U.S.
column d.
Secretary of the Treasury or the Commissioner of Taxation and
Line 2 — Enter the total number of gallons from Schedule B,
Finance. (Currently designated delivery services are listed in
column d.
Publication 55, Designated Private Delivery Services. See Need
help? below for information on ordering forms and publications.) If
Line 3 — Enter the total number of gallons from Schedule D,
you use any private delivery service, whether it is a designated
column d.
service or not, address your return to: NYS Tax Department,
Line 4 — Add lines 1, 2, and 3.
TTTB/FACCTS - Fuels Unit, Building 8, WA Harriman Campus,
Albany NY 12227.
Line 5 — Enter the rate per gallon of petroleum business tax that
you paid on the diesel motor fuel to your supplier. If you paid
more than one rate of petroleum business tax on the diesel motor
Privacy notification
fuel, enter various on line 5, show the result of your computation
The Commissioner of Taxation and Finance may collect and maintain
on line 6 from a separate schedule, and attach the schedule to this
personal information pursuant to the New York State Tax Law, including but
form. Petroleum business tax rates are listed in Publication 908,
not limited to, sections 171, 171-a, 287, 308, 429, 475, 505, 697, 1096,
1142, and 1415 of that Law; and may require disclosure of social security
Fuel Tax Rates.
numbers pursuant to 42 USC 405(c)(2)(C)(i).
Line 6 — Multiply the total number of gallons on line 4 by the tax
This information will be used to determine and administer tax liabilities and,
rate on line 5. This is the amount of petroleum business tax on
when authorized by law, for certain tax offset and exchange of tax
diesel motor fuel to be reimbursed.
information programs as well as for any other lawful purpose.
Motor fuel section
Information concerning quarterly wages paid to employees is provided to
certain state agencies for purposes of fraud prevention, support
Line 7 — Enter the total number of gallons from Schedule B,
enforcement, evaluation of the effectiveness of certain employment and
training programs and other purposes authorized by law.
column e.
Failure to provide the required information may subject you to civil or
Line 8 — Enter the total number of gallons from Schedule C,
criminal penalties, or both, under the Tax Law.
column d.
This information is maintained by the Director of the Registration and Data
Line 9 — Enter the total number of gallons from Schedule D,
Services Bureau, NYS Tax Department, Building 8, Room 338,
column e.
W A Harriman Campus, Albany NY 12227; telephone 1 800 225-5829. From
areas outside the United States and Canada, call (518) 485-6800.
Line 10 — Add lines 7, 8, and 9.
Line 11 — Enter the rate per gallon of petroleum business tax that
you paid on the motor fuel to your supplier. If you paid more than
Need help?
one rate of petroleum business tax on the motor fuel, enter various
Tax information: 1 800 972-1233
on line 11, show the result of your computation on line 12 from a
Forms and publications: 1 800 462-8100
separate schedule, and attach the schedule to this form. Petroleum
From outside the U.S. and outside Canada: (518) 485-6800
business tax rates are listed in Publication 908, Fuel Tax Rates .
Fax-on-demand forms: 1 800 748-3676
Line 12 — Multiply the total number of gallons on line 10 by the tax
Internet access:
rate on line 11. This is the amount of petroleum business tax on
Hearing and speech impaired (telecommunications device for the
motor fuel to be reimbursed.
deaf (TDD) callers only): 1 800 634-2110
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