Form Mf-023w - Nonagricultural Users - Off-Road Fuel Tax Refund Claim Page 2
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1
2INFORMATION AND INSTRUCTIONS
Wisconsin law provides that persons who use motor vehicle fuel for any
Line 1.
Indicate the total gallons purchased and used per fuel type.
purpose other than operating a motor vehicle upon public highways may
receive a refund of the Wisconsin fuel tax paid when purchasing the fuel.
Line 2.
In each column indicate the gallons included on line 1 that were
Motor vehicle fuel includes gasoline (gasohol) and undyed diesel fuel.
used in your licensed cars and trucks.
Exceptions – Refunds may NOT be claimed on fuel purchased for use in
Ready-mix, waste management, liquid waste (e.g., septic) and utility
the following vehicles:
companies that have vehicles with power take-off units that share the
same fuel supply tank used to power the vehicle – On line 2 enter 65%
1.
Snowmobiles
(if ready-mix), 70% (if waste management), 85% (if liquid waste), 85% (if
2.
Recreational motorboats
boom or derrick / digger trucks with 20,000 GVW or less), or 70% (if
3.
All-terrain vehicles unless registered for private use
boom or derrick / digger trucks greater than 20,000 GVW) of the total
4.
Aircraft
gallons used in power take-off vehicles plus 100% of the gallons used in
other licensed vehicles.
HOW TO OBTAIN A REFUND
A refund can only be obtained by completing this claim form and filing it
Line 3.
Subtract line 2 from line 1 in each column and enter the totals
with the Wisconsin Department of Revenue.
on this line in the respective columns. Then add the gallons entered in
each column on line 3, and enter the total on line 6.
DUE DATE
You may file a refund claim any time during the year (for example, quar-
Line 4.
Enter the fuel tax rate that corresponds to the dates of your fuel
terly, semi-annually, annually). A CLAIM MUST BE FILED WITHIN 12
purchases. Use a separate claim form for each fuel tax rate period.
MONTHS FROM THE DATE FUEL IS PURCHASED. It is date of pur-
chase (not date of payment) that determines the due date of your refund
Line 5.
Multiply the gallons in each column on line 3 by the fuel tax rate
claim.
on line 4. Enter the results on line 5 in the appropriate columns. Then
add the amounts entered in each column on line 5 and enter your total
INVOICE REQUIREMENTS
refund on line 7/8.
Invoices verifying your fuel purchases must accompany your claim.
Submit a separate invoice for each purchase (grouping purchases on
Line 6.
TOTAL GALLONS. Add all columns on line 3 and enter the
one invoice is not acceptable). The invoices are part of your refund
total gallons on line 6.
claim and will not be returned to you.
Each invoice prepared by your supplier must contain the following infor-
Line 7/8.
TOTAL REFUND. Add all columns on line 5 and enter the
mation:
total on line 7/8. THIS IS YOUR REFUND.
1.
Date of purchase
Section D:
2.
Name and address of purchaser
Column A.
List the activity type from the following: ready mix; waste
3.
Name and address of seller
management; liquid waste pumping truck; urban mass transit; boom
4.
Number of gallons purchased
trucks and derrick /digger trucks; and other off-road equipment.
5.
Type of fuel purchased
Column B.
List the equipment type and manufacturer name.
6.
Amount of Wisconsin fuel tax paid
Column C.
List the fuel type used in the equipment type.
In addition, the invoices you submit must be grouped by fuel type and
Column D.
List the 100% gallons used in the equipment type.
tax rate, and then assembled in ascending date order (oldest invoice
Column E.
Enter the allowable percent for each activity type. The
first). Your invoices must be accompanied by adding machine tapes to
following percentages are allowed for ready-mix, waste management,
show how you computed the gallons entered in the columns on line 1.
liquid waste (e.g., septic) and utility companies that have vehicles with
Attach (staple/clip) each adding machine tape to the invoices covered
power take-off units that share the same fuel supply tank used to power
by that tape.
the vehicle:
Computer Printouts – The department will accept computer listings of
1.
Ready mix 35%
fuel purchases in lieu of invoices. Call (608) 266-7363 for more informa-
2.
Waste management 30%
tion.
3.
Liquid waste 15%
4.
Urban Mass Transit 100%
GALLON LIMITATION FOR CLAIMS SUBMITTED
5.
Boom & derrick/digger trucks < or = 20,000 GVW 15%
All refund claims submitted must be for 100 gallons or more. Claims
6.
Boom & derrick/digger trucks > 20,000 GVW 30%
submitted for less than 100 gallons will be returned.
7.
All other off-road equipment should use 100%.
Column F.
Multiply the gallons in column D by the allowable percent in
ASSISTANCE
column E. The total gallons on this line, column F, must agree with the
If you need additional claim forms or have any questions, contact us at
total gallons you enter on line 6.
(608) 266-7363 or (608) 266-6701, FAX (608) 261-7049, or e-mail:
excise@dor.state.wi.us.
Sign and date your refund claim, and indicate your business telephone
number.
POTENTIAL USE TAX LIABILITY
As a result of filing this claim form and receiving a refund, you may be
DEPARTMENT REVIEW OF REFUND CLAIMS
subject to the 5% Wisconsin use tax on your fuel purchases. This tax
The department reserves the right to review and adjust refund claims
does not apply to fuel used for agricultural purposes by a person en-
either before or after refund checks are issued.
gaged in farming. For more information, call (608) 266-2776.
RECORD KEEPING
COMPLETING YOUR REFUND CLAIM
You must keep a copy of this refund claim and all records pertaining to
Section A
: The FEIN/SSN you enter must be issued to the name shown.
your business for at least 4 years. Store them in a place that is easily
Section B:
accessible for review by department representatives.
Enter the dates of the first and last fuel purchases for the
time period covered by your refund claim.
FRAUDULENT CLAIMS
Under section 78.73(1) of the Wisconsin Statutes, any person who uses
Section C: REFUND COMPUTATION SCHEDULE
a false or fictitious name when submitting a refund claim or commits any
Before you complete this schedule, separate your fuel purchases by
other fraud in preparing and submitting a claim, may be fined not more
date (see the dates listed on this schedule) and type of fuel (gasoline
than $500 or imprisoned not more than 6 months or both. Altering a
including gasohol and undyed diesel fuel).
purchase date on an invoice to bring it within the 12 month time limita-
tion for filing a refund claim is a fraudulent act.
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