Form Mc060 - Nevada Dmv Motor Carrier Division Motor Vehicle Fuel (Diesel) Tax Refund Request Farmer And/or Rancher

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NEVADA DMV MOTOR CARRIER DIVISION
MOTOR VEHICLE FUEL (DIESEL) TAX REFUND REQUEST
FARMER AND/OR RANCHER
_________________________________________________ Account No._______________________________________
Name of Claimant
_________________________________________________
Street Address or P. O. Box Number
_________________________________________________
(
) CHECK HERE IF YOU HAVE A NEW ADDRESS
City
State
Zip Code
GENERAL INSTRUCTIONS AND INFORMATION
1. Bulk purchases means purchases in excess of 50 gallons of diesel. (Do not include gasoline fuel.)
2. Any person determined by the Department to be a bona fide farmer or rancher not engaged in other activities which
would distort highway usage may claim a refund on the basis of 80 percent of bulk purchases without the necessity of
maintaining records. A farmer or rancher wishing to claim a refund must first secure a permit from the NEVADA DMV
MOTOR CARRIER DIVISION
3. Claims for refund must be submitted within 12 months from the date of the earliest invoice and must be for bulk
purchases that total of a minimum of 200 gallons. Name on invoice must match name on Diesel Tax Refund
Account.
5. List invoices below and attach them to this claim.
6. Send this application, properly signed, with invoices attached to: Nevada DMV Motor Carrier Division, 555 Wright Way,
Carson City, Nevada 89711.
NUMBER
NUMBER
NUMBER
INVOICE
INVOICE
OF GALLONS
INVOICE
INVOICE
OF GALLONS
INVOICE
INVOICE
OF GALLONS
NUMBER
DATE
PURCHASED
NUMBER
DATE
PURCHASED
NUMBER
DATE
PURCHASED
.2646 CENTS
Use whole gallons only
(STATE)
Total gallons purchased (Diesel)
Less 20 percent for highway use
Total gallons claimed for refund
minimum 200 gallons
Rate of refund
Refund amount
County in which diesel was TAXED ________________________
NOTE: Submit a separate claim for each county in which you purchased fuel for which you are claiming a refund.
I, the undersigned, certify the fuel claimed for refund as stated above, and documented by the attached invoices, was
purchased and used in a farm or ranch operation, not more than 20 percent was used on public roads or highways, the dates
shown on the invoices are true and correct, and I am entitled to a refund under the provisions of NRS 366.
Claimant or Authorized Signature: ________________________________________________ Date ______________
Phone___________________________ Email Address: _________________________________________________
Federal Identification or Social Security Number: __________________________ (
) Check here if you need more forms
MC060 (04/2016)

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