Form Mf-003w - Agricultural Users Off-Road Fuel Tax Refund Claim (Page 2 of 2) in pdf

INFORMATION AND INSTRUCTIONS

Wisconsin law provides that persons who use motor

name and ID numbers you enter on other tax documents

vehicle fuel for any purpose other than operating a motor

you file with the department.

vehicle upon public highways may receive a refund of the

Line 7. Enter the dates of the first and last fuel purchases

Wisconsin fuel tax paid when purchasing the fuel. Motor

for the time period covered by your refund claim.

vehicle fuel includes gasoline (gasohol) and undyed

diesel fuel.

REFUND COMPUTATION SCHEDULE

Exceptions – Refunds may NOT be claimed on fuel

Before you complete this schedule to compute your

purchased for use in the following vehicles:

refund, separate your fuel purchases by date (see the

dates listed on this schedule) and type of fuel (gasoline

1. Snowmobiles

including gasohol and undyed diesel fuel).

2. Recreational motorboats

3. All-terrain vehicles unless registered for private use

Line 11. Enter the fuel tax rates that correspond to the

4. Aircraft

dates of your fuel purchases. If you enter more than

two fuel tax rates on line 11, your claim cannot be

HOW TO OBTAIN A REFUND

processed.

A refund can only be obtained by completing this claim

form and filing it with the Wisconsin Department of

Line 12. Indicate the total gallons purchased and used

Revenue.

per fuel type at each tax rate.

DUE DATE

Line 13. In each column indicate the number of gallons

You may file a refund claim any time during the year (for

entered on line 12 that were used in your licensed cars

example, quarterly, semi-annually, annually). A CLAIM

and trucks, including licensed vehicles such as a pick-up

MUST BE FILED WITHIN 12 MONTHS FROM THE

truck used to transport farm supplies or check on animals

DATE FUEL IS PURCHASED. It is date of purchase (not

or crops in the field. A vehicle is licensed when it has

date of payment) that determines the due date of your

been issued a license plate by the Wisconsin Department

refund claim.

of Transportation for traveling public roads in Wisconsin.

INVOICE REQUIREMENTS

Line 14. Subtract line 13 from line 12 in each column and

Invoices verifying your fuel purchases must accompany

enter the totals on this line in the respective columns.

your claim. You must submit a separate invoice for each

Then add the gallons entered in all the columns on line

purchase (grouping purchases on one invoice is not

14, and enter the total on line 16a.

acceptable). The invoices are part of your refund claim

and will not be returned to you.

Line 15. Multiply the gallons in each column on line 14

by the fuel tax rate on line 11. Enter the results on line

Each invoice prepared by your supplier must contain the

15 in the appropriate columns. Then add the amounts

following information:

entered in all the columns on line 15, and enter your total

refund on line 16b.

1. Date of purchase

2. Name and address of purchaser

Line 16a. TOTAL GALLONS. Add all columns on line 14

3. Name and address of seller

and enter the total gallons on line 16a.

4. Number of gallons purchased

5. Type of fuel purchased

Line 16b. TOTAL REFUND. Add all columns on line 15

6. Amount of Wisconsin fuel tax paid

and enter the total on line 16b. THIS IS YOUR REFUND.

In addition, the invoices you submit must be grouped by

Line 17. Indicate the equipment used for off-road

fuel type and tax rate, and then assembled in ascending

purposes (check all the boxes that apply to your farming

date order (oldest invoice first). Your invoices must also

operation).

be accompanied by adding machine tapes to show how

you computed the gallons entered in the various columns

Sign and date your refund claim, and indicate your

on line 12. Attach (staple/clip) each adding machine tape

business telephone number.

to the 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

refund claims either before or after refund checks are

more. If you submit a claim for less than 100 gallons, it

issued.

will be 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 in a place that is easily accessible for review by

261-7049, or e-mail: excise@dor.state.wi.us.

department 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

you may be subject to the 5% Wisconsin use tax on your

person who uses a false or fictitious name when

fuel purchases. This tax does not apply to fuel used for

submitting a refund claim or commits any other fraud in

agricultural purposes by a person engaged in farming.

preparing and submitting a claim, may be fined not more

For more information, call (608) 266-2776.

than $500 or imprisoned not more than 6 months or both.

Altering a purchase date on an invoice to bring it within

COMPLETING YOUR REFUND CLAIM

the 12 month time limitation for filing a refund claim is a

fraudulent act.

Line 2. The number(s) you enter here must be issued to

the name entered on line 1, and both must agree with the

Form Mf-003w - Agricultural Users Off-Road Fuel Tax Refund Claim Page 2

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