Form 72a067 - Application For Approval To Receive A Refund Of Aviation Motor Fuels - 2009
ADVERTISEMENT
172A067 (4-09)
APPLICATION FOR APPROVAL TO RECEIVE
Commonwealth of Kentucky
A REFUND OF AVIATION MOTOR FUELS
DEPARTMENT OF REVENUE
Pursuant to Kentucky Revised Statutes 138.341 and 138.342, a refund of Kentucky tax may be obtained on gasoline or special fuel used
or sold for the operation of aircraft.
Name of Business (Enter Exact Business Name) ______________________________________________________________
Mailing Address ________________________________________________________________________________________
P .O. Box or No. and Street
City or Town
State
ZIP Code
Telephone (daytime) (
)
E-mail Address
Location of
Business _____________________________________________________________________________________________
No. and Street or Hwy.
City or Town
County and State
Name of Airport
1. Indicate type of ownership:
Individual
Partnership
Corporation
Other (description) ___________________
_________________________________________________________________________________________________
2. Give the name of previous owner(s), if any __________________________________________________________________
3. Can motor vehicles be fueled from these facilities?
Yes
No
4. Do you sell aviation gasoline or special fuel at this location for purposes other than use in aircraft?
Yes
No
If yes, explain _______________________________________________________________________________________
5. Do you sell aviation gasoline or special fuels at this location for purposes other than your own use?
Yes
No
If yes, explain _______________________________________________________________________________________
6. Give the name and address of all suppliers of aviation refund motor fuels ___________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
COMPLETE IF INDIVIDUAL OWNERSHIP
COMPLETE IF CORPORATION
–
Name of Owner
Social Security No.
F.E.I.N.
Driver’s License No.
Officer Name
Social Security No.
COMPLETE IF PARTNERSHIP
Name of Owner
Social Security No.
Officer Name
Social Security No.
Driver’s License No.
Officer Name
Social Security No.
Name of Owner
Social Security No.
Driver’s License No.
(Attach list if necessary.)
(Attach list if necessary.)
This application shall be accompanied by a corporate surety bond in an amount of $1,000. All records must be retained for a period of four years
including all sales invoices which have been assigned to you by the purchaser on which a refund claim may be filed.
I declare under penalties of perjury that this application is made in good faith, and the answers given to the questions are true and correct to the
best of my knowledge and belief.
Signature of Applicant
Title
Date of Application
Mail application to Motor Fuels Tax Compliance Section, Department of Revenue, P.O. Box 1303, Frankfort, Kentucky 40602-1303.
ADVERTISEMENT
0 votes
Related Articles
Related forms
Form 72a073 - Application For Approval To Receive A Refund Of Tax On Motor Fuels Consumed By City And Suburban Buses, Nonprofit Buses, Senior Citizen Transportation, And Taxicabs
Financial
State Form 8200 - Application For License To Operate A Health Faclity - Indiana State Department Of Health
Legal
Related Categories
Parent category: Financial