Form Mf-003w - Agricultural 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
COMPLETING YOUR REFUND CLAIM
vehicle fuel for any purpose other than operating a motor
Section A: The FEIN/SSN you enter must be issued to
vehicle upon public highways may receive a refund of the
the name shown.
Wisconsin fuel tax paid when purchasing the fuel. Motor
Section B: Enter the dates of the first and last fuel
vehicle fuel includes gasoline (gasohol) and undyed
purchases for the time period covered by your refund
diesel fuel.
claim.
Exceptions – Refunds may NOT be claimed on fuel
Section C: REFUND COMPUTATION SCHEDULE
purchased for use in the following vehicles:
Before you complete this schedule, separate your fuel
purchases by date (see the dates listed on this
1. Snowmobiles
schedule) and type of fuel (gasoline including gasohol
2. Recreational motorboats
and undyed diesel fuel).
3. All-terrain vehicles unless registered for private use
4. Aircraft
Line 1. Indicate the total gallons purchased and used
per fuel type.
HOW TO OBTAIN A REFUND
A refund can only be obtained by completing this claim
Line 2. In each column indicate the number of gallons
form and filing it with the Wisconsin Department of
entered on line 1 that were used in your licensed cars
Revenue.
and trucks, including licensed vehicles such as a pick-up
truck used to transport farm supplies or check on animals
DUE DATE
or crops in the field. A vehicle is licensed when it has
You may file a refund claim any time during the year (for
been issued a license plate by the Wisconsin Department
example, quarterly, semi-annually, annually). A CLAIM
of Transportation for traveling public roads in Wisconsin.
MUST BE FILED WITHIN 12 MONTHS FROM THE
DATE FUEL IS PURCHASED. It is date of purchase (not
Line 3. Subtract line 2 from line 1 in each column and
date of payment) that determines the due date of your
enter the totals on this line in the respective columns.
Then add the gallons entered in each column on line 3,
refund claim.
and enter the total on line 6.
INVOICE REQUIREMENTS
Line 4. Enter the fuel tax rate that corresponds to the
Invoices verifying your fuel purchases must accompany
dates of your fuel purchases.
Use a separate claim
your claim. You must submit a separate invoice for each
form for each fuel tax rate period.
purchase (grouping purchases on one invoice is not
acceptable). The invoices are part of your refund claim
Line 5. Multiply the gallons in each column on line 3 by
and will not be returned to you.
the fuel tax rate on line 4. Enter the results on line 5 in
the appropriate columns.
Then add the amounts
Each invoice prepared by your supplier must contain the
entered in each column on line 5 and enter your total
following information:
refund on line 7/8.
1. Date of purchase
Line 6. TOTAL GALLONS. Add all columns on line 3
2. Name and address of purchaser
and enter the total gallons on line 6.
3. Name and address of seller
4. Number of gallons purchased
Line 7/8. TOTAL REFUND. Add all columns on line 5
and enter the total on line 7/8.
THIS IS YOUR
5. Type of fuel purchased
REFUND.
6. Amount of Wisconsin fuel tax paid
In addition, the invoices you submit must be grouped by
Section D: 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 1. 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
contact us at (608) 266-7363 or 266-6701, FAX (608)
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
the 12 month time limitation for filing a refund claim is a
fraudulent act.
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