Form Mf-003w - Agricultural Users - Off-Road Fuel Tax Refund Claim Page 2
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INFORMATION AND INSTRUCTIONS
Wisconsin law provides that persons who use motor ve-
COMPLETING YOUR REFUND CLAIM
hicle fuel for any purpose other than operating a motor ve-
Section A: The FEIN/SSN you enter must be issued to the
hicle upon public highways may receive a refund of the
name shown.
Wisconsin fuel tax paid when purchasing the fuel. Motor
Section B: Enter the dates of the first and last fuel pur-
vehicle fuel includes gasoline (gasohol) and undyed diesel
chases for the time period covered by your refund claim.
fuel.
Section C: REFUND COMPUTATION SCHEDULE
Exceptions – Refunds may NOT be claimed on fuel pur-
Before you complete this schedule, separate your fuel pur-
chased for use in the following vehicles:
chases by date (see the dates listed on this schedule) and
1. Snowmobiles
type of fuel (gasoline including gasohol and undyed diesel
2. Recreational motorboats
fuel).
3. All-terrain vehicles unless registered for private use
Line 1. Indicate the total gallons purchased and used per
4. Aircraft
fuel type.
HOW TO OBTAIN A REFUND
Line 2. In each column indicate the number of gallons
A refund can only be obtained by completing this claim form
entered on line 1 that were used in your licensed cars and
and filing it with the Wisconsin Department of Revenue.
trucks, including licensed vehicles such as a pick-up truck
DUE DATE
used to transport farm supplies or check on animals or
You may file a refund claim any time during the year (for
crops in the field. A vehicle is licensed when it has been
example, quarterly, semi-annually, annually). A CLAIM
issued a license plate by the Wisconsin Department of
MUST BE FILED WITHIN 12 MONTHS FROM THE DATE
Transportation for traveling public roads in Wisconsin.
FUEL IS PURCHASED. It is date of purchase (not date of
Line 3. Subtract line 2 from line 1 in each column and
payment) that determines the due date of your refund claim.
enter the totals on this line in the respective columns. Then
INVOICE REQUIREMENTS
add the gallons entered in each column on line 3, and
Invoices verifying your fuel purchases must accompany your
enter the total on line 6.
claim. You must submit a separate invoice for each pur-
Line 4. Enter the fuel tax rate that corresponds to the dates
chase (grouping purchases on one invoice is not accept-
of your fuel purchases. Use a separate claim form for each
able). The invoices are part of your refund claim and will
fuel tax rate period.
not be returned to you.
Line 5. Multiply the gallons in each column on line 3 by the
Each invoice prepared by your supplier must contain the
fuel tax rate on line 4. Enter the results on line 5 in the
following information:
appropriate columns. Then add the amounts entered in
1. Date of purchase
each column on line 5 and enter your total refund on line
2. Name and address of purchaser
7/8.
3. Name and address of seller
Line 6. TOTAL GALLONS. Add all columns on line 3 and
4. Number of gallons purchased
enter the total gallons on line 6.
5. Type of fuel purchased
6. Amount of Wisconsin fuel tax paid
Line 7/8. TOTAL REFUND. Add all columns on line 5 and
enter the total on line 7/8. THIS IS YOUR REFUND.
In addition, the invoices you submit must be grouped by
fuel type and tax rate, and then assembled in ascending
Section D: Indicate the equipment used for off-road
date order (oldest invoice first). Your invoices must also be
purposes (check all the boxes that apply to your farming
accompanied by adding machine tapes to show how you
operation).
computed the gallons entered in the various columns on
Sign and date your refund claim, and indicate your business
line 1. Attach (staple/clip) each adding machine tape to the
telephone number.
invoices covered by that tape.
DEPARTMENT REVIEW OF REFUND CLAIMS
GALLON LIMITATION FOR CLAIMS SUBMITTED
The department reserves the right to review and adjust
All refund claims submitted must be for 100 gallons or more.
refund claims either before or after refund checks are
If you submit a claim for less than 100 gallons, it will be
issued.
returned to you.
RECORD KEEPING
ASSISTANCE
You must keep a copy of this refund claim and all records
If you need additional claim forms or have any questions,
pertaining to your business for at least 4 years. Store them
contact us at (608) 266-7363 or 266-6701, FAX (608) 261-
in a place that is easily accessible for review by depart-
7049, or e-mail: excise@dor.state.wi.us.
ment representatives.
POTENTIAL USE TAX LIABILITY
FRAUDULENT CLAIMS
As a result of filing this claim form and receiving a refund,
Under section 78.73(1) of the Wisconsin Statutes, any per-
you may be subject to the 5% Wisconsin use tax on your
son who uses a false or fictitious name when submitting a
refund claim or commits any other fraud in preparing and
fuel purchases. This tax does not apply to fuel used for
submitting a claim, may be fined not more than $500 or
agricultural purposes by a person engaged in farming. For
imprisoned not more than 6 months or both. Altering a pur-
more information, call (608) 266-2776.
chase date on an invoice to bring it within the 12 month
time limitation for filing a refund claim is a fraudulent act.
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