Form 82-011 - Casualty Loss/special Fuel Blending Error
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1Iowa Department of Revenue
Casualty Loss/Special Fuel Blending Error
Send this claim to: Iowa Department of Revenue
82-011 (5/21/04)
Name of
Motor Fuel Unit
Claimant ______________________
Examination Section
Attach to Form 82-006
P.O. Box 10456
FEIN _________________________
Des Moines, IA 50306-0456
Exact location of loss
Cause of loss
Procedure followed in determining amount of loss
Bill of lading
Bill of lading
Gallons listed
I f l o s s o c c u r re d w h i l e i n
Date of loss
No. of gallons
Type of fuel
date
number
upon request
t r a n s i t o r a t t h e t i m e o f
u n l o a d i n g , c o m p l e t e t h e
section at right, providing
Accompany claim with proof of loss in the
From whom purchased - Company/Person, City, State
information from the bill of
form of an affidavit from the person having
lading (manifest) or invoice
custody of the fuel at the time of the loss.
and indicating your seller.
To claim a refund on fuel lost or destroyed through fire, explosion, light-
If the fuel was in storage where several fuel purchases were commingled,
ning, flood, storm, or other casualty, the taxpayer must first submit written
the department will presume the fuel lost was a part of the last delivery into
notification of the loss to the department within 10 days of the loss. The
the storage just prior to the loss. If the quantity of fuel lost exceeds the
notification must state the quantity of fuel lost or destroyed. Losses of 100
quantity of the last delivery into storage, this presumption will extend to
gallons or less are not subject to refund. The mailing address for this
the second-to-last delivery, then the third-to-last delivery, and so on. This
notification is Iowa Department of Revenue, Examination Section, Motor
presumption will apply unless the taxpayer presents clear evidence to the
Fuel Unit, P.O. Box 10456, Des Moines, Iowa 50306-0456.
contrary. Fuel lost through evaporation or unknown causes is not subject to
refund.
CASUALTY LOSS CLAIMS must be submitted to the department on this
SPECIAL FUEL BLENDING ERRORS. Claims must be filed on this
schedule and form 82-006 within 60 days from the date of the notification
schedule and form 82-006, along with documentation on how the gallon-
mentioned in the preceding paragraph. An affidavit or report from the
age was determined.
person having custody of the fuel at the time of the loss must be attached
to the claim. Affidavits from other persons with sufficient knowledge of
Dyed special fuel commingled with undyed special fuel. If dyed special
the circumstances surrounding a casualty loss such as police officers and
fuel is inadvertently mixed with tax-paid undyed special fuel to the extent
firefighters should also be provided if available. The affidavit or report
that the undyed fuel must have additional dye added to meet federal dying
must explain in full detail the circumstances of the loss and the quantity of
requirement to qualify as exempt dyed fuel, the tax is refundable on the
fuel lost.
undyed special fuel. The refund must contain the number of gallons of
undyed fuel lost through the mixing error.
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