Instructions For Form 84 - Nebraska Motor Fuels Tax Refund Claim printable pdf download

INSTRUCTIONS

Caution: Only federal governmental agencies, Native Americans, and buses for hire are eligible for the refund of tax on fuel placed

into a licensed motor vehicle. All other users of fuel in licensed motor vehicles, regardless of how those vehicles are used,

cannot claim refund on such fuel.

All refund claims are subject to audit for three years after the claim is ﬁled.

NOTE:

WHO MAY FILE. Any person requesting a refund of taxes paid or

agency or by a Native American who is a resident of a Nebraska

Indian Reservation and the sale is made on a Nebraska Indian

for overpayment of Nebraska fuel taxes may ﬁle a Nebraska Motor

Fuels Tax Refund Claim, Form 84. Prior to adjustments, the refund

Reservation, the agency or Native American may ﬁle a claim

for refund.

must be at least $25. This minimum must be met within a calendar

year for each fuel type except Petroleum Release Remedial Action

Documentation to be submitted: Copies of invoices and other

Fee, which has a $10 minimum.

supporting records.

BASIS FOR CLAIM. Indicate reason for the claim. If the space

SPECIFIC INSTRUCTIONS FOR CALCULATING THE

provided is not sufﬁcient, attach an additional sheet of paper. For

REFUND

refunds of diesel, gasoline, gasohol and ethanol, you must answer

Multiply the number of gallons claimed by the refund rate in effect

the question regarding bulk storage. Appropriate documentation

when the fuel was purchased and enter the amount calculated.

Round

must be attached to the Form 84. Documentation submitted with the

down all amounts less than .50 and round up all amounts of .50

Form 84 will not be returned.

through .99. If gallons are claimed for periods with multiple refund

Exempt Use of Tax-Paid Diesel, Gasoline, Gasohol,

rates, attach summary on another piece of paper.

and Ethanol. Any person who has purchased and used

tax-paid fuel for a qualiﬁed exempt purpose may ﬁle a claim.

Refund Rates. For fuel purchased during tax years ending on or

(Motor vehicle fuels purchased during tax years ending on or

after January 1, 2005, the refund of the tax paid on fuel consumed in a

after January 1, 2005 are eligible for this refund. For tax years

qualiﬁed exempt manner is determined at a reduced rate. The reduction

ending prior to 2005, qualifying use of such fuels is claimed

from the tax rate paid is $0.01 per gallon for diesel and $0.035 per gallon

as an income tax credit.)

for gasoline and gasohol. Federal agencies and Native Americans are

not subject to the reduced rate and are entitled to a refund of the entire

Documentation to be submitted:

tax paid. To claim the correct rate, please refer to the refund rate table

• Description of your operations must be submitted with the

found at

initial claim and on an annual basis thereafter. For example,

for agricultural use, this information includes the number

Adjustments. Determine the refund claimed net of any appropriate

of acres farmed, types of crops raised, and the number and

adjustments for commission or consumer’s use tax. If you are a motor

type of livestock;

vehicle fuels, diesel fuel, or aircraft fuel licensee, you may need to

deduct the appropriate commission.

• Type of equipment in which the fuel was used. An equipment

list must be submitted with the initial claim and on an annual

Persons who purchase undyed diesel fuel for reefer units, home

basis thereafter, and include the make, horsepower, and other

heating, or any other use which subjects it to the sales and use tax, must

mechanical description of the machinery;

remit the state and city use tax on a Nebraska and Local Consumer’s

Use Tax Return, Form 2, or on the appropriate line on Nebraska and

• Copies of purchase invoices indicating the amount of tax

Local Sales and Use Tax Return, Form 10. If the appropriate use

paid, date of purchase, and vendor’s name; and

tax is not paid, the refund will be reduced by the amount of use tax

• Copies of withdrawal logs documenting the date, gallons and

determined to be due.

equipment into which the fuel was placed if both licensed

vehicles and unlicensed equipment are fueled from the same

If you are claiming a refund for tax paid on gasoline, gasohol or ethanol

storage facility. Refer to the Nebraska Motor Fuels Tax

which was subsequently used to fuel an airplane, the claim must be

Refunds Information Guide for additional information.

reduced by the aviation gasoline tax rate of $0.05 per gallon.

Exports of Tax-Paid Fuel, Including the Petroleum

WHEN TO FILE. Only one claim per month may be ﬁled by any

Release Remedial Action Fee. Any person who is not

claimant. You must ﬁle your claim within three years from the date of

currently licensed or required to be licensed, who owned and

payment of the tax. Claims ﬁled for refunds of tax paid on aviation jet

exported fuel upon which Nebraska fuels tax was previously

fuel or aviation gasoline used in the operation of a FAA-approved air

paid may ﬁle a claim.

school must be ﬁled within seven months of the date of purchase.

Documentation to be submitted: Copies of invoices or other

WHERETO FILE. This claim, along with supporting documentation,

supporting records that indicate the fees were paid to a motor

must be ﬁled with the Motor Fuels Division, P.O. Box 98904, Lincoln,

fuel licensee and to what state the fuel was exported.

NE 68509-8904.

Destroyed or Contaminated Tax-Paid Fuel. Any person

SIGNATURES. This clam must be signed by the claimant, partner

who owned fuel upon which Nebraska fuels tax was previously

or corporate ofﬁcer. If the claimant authorizes another person to sign

paid, and such fuel is subsequently destroyed or accidentally

this claim, such person must attach an original power of attorney.

contaminated with another type of fuel may ﬁle a claim.

Any person who is paid for preparing a claim must also sign the

Documentation to be submitted: Date destroyed or

claim as preparer.

contaminated, number of gallons destroyed or contaminated,

TAXPAYER’S ASSISTANCE. Additional information is found

owner of fuel, copies of purchase invoices, inventory records,

If you need further information

and copies of insurance claims.

or have any questions concerning this claim for refund, contact the

Federal Governmental Agencies and Native American

Motor Fuels Division toll free 800-554-3835. Lincoln residents may

Transactions. If fuel is purchased tax-paid by a federal

call 471-5730.

Instructions For Form 84 - Nebraska Motor Fuels Tax Refund Claim

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