Form 04-544 - User Claim For Refund Motor Fuel Tax Page 3
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5Alaska Department of Revenue
User Claim for Refund
Schedule of Non-Highway Motor Fuel Use
Range of Dates for Fuel Purchased
Name:____________________________________________
From:
/
/
EIN or SSN:________________________________________
To:
/
/
Fuel Type: (Check only one box)
DESCRIPTION OF EQUIPMENT.
First refund claim. If this is your first User Claim for Refund this
65 Gasoline
calendar year, list below all equipment (including non-licensed vehicles) that
124 Gasohol
use motor fuel. If you prefer, attach a separate list and use this schedule only
for the equipment that used fuel for which you are now claiming a refund.
125 Aviation Gasoline
Subsequent refund claims. If you have already filed a User
Claim for Refund this calendar year, list below only the equipment that
130 Jet Fuel
used fuel for which you are now claiming a refund.
160 Diesel
PURPOSE OF USE. Describe the manner in which the fuel was used;
i.e. road construction, mining, electrical generation > 100 kw, etc. Complete
this column only for equipment that used fuel for which you are now
Note: Do not include fuel used in a licensed motor vehicle.
claiming a refund.
Serial
Number of
Number
Purpose of Use
Gallons
Description of Equipment
Total Gallons (Carry forward to page 1, line 16)
Attach this schedule to your User Claim for Refund . Use additional sheets as necessary.
Form 04-544.7 (Revised 6/97)
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