Form Au-724 - Motor Vehicle Fuels Tax Refund Claim - Off Highway, Marine, Governmental, School Bus, And Waste Hauling Use
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1
2Department of Revenue Services
Form AU-724
(For DRS Use Only)
State of Connecticut
Excise Taxes Unit
Motor Vehicle Fuels Tax Refund Claim
2013
Period of claim in calendar year
25 Sigourney St Ste 2
Hartford CT 06106-5032
Off Highway, Marine, Governmental, School Bus,
/
/
__ __ through __ __
__ __
__ __
(Rev. 06/13)
and Waste Hauling Use
m
m
d
d
m
m
d
d
Connecticut Tax Registration Number
Refund claims must be fi led on or before May 31, 2014, for fuel used during calendar year 2013. You must
check the appropriate fuel type box at right. Complete this refund claim in blue or black ink only.
Print name of claimant
Telephone number
Type of business
Federal Employer Identifi cation Number (FEIN)
(
)
Social Security Number (SSN)
Number and street
Check if change of address
Fuel type:
Diesel
City or town
State
ZIP code
Motor vehicle fuels (gasoline-gasohol)
Claim type:
Off highway
Marine
Location of records if different from above
Governmental
School bus
Waste hauling for CRRA
Schedule A
- Statement of motor vehicle fuel purchases: Receipts must be attached. Attach additional sheet(s) as necessary to provide a complete response.
Date
Name of Supplier
Gallons of Fuel
Date
Name of Supplier
Gallons of Fuel
Total:
Round to the nearest whole gallon.
Schedule B
- Statement of nontaxable use: List the number of pieces of each type of equipment and the number of gallons of fuel used in each.
Qty.
Type of Equipment
Gallons
Qty.
Type of Equipment
Gallons
Qty.
Type of Equipment
Gallons
Backhoes
Lighting units
Road rollers and scrapers
Bulldozers
Motor boats -
School buses: See instructions.
Registration number(s)
Carburetor - engine tests
Tow motors
Cement - mixer units
Government vehicles:
Unregistered vehicles:
Attach list.
See Instructions.
Power saws - mowers
Waste hauling for CRRA
Compressors
Cranes
Power shovels
Mid-Connecticut Project
Fork lifts and hoists
Pumping units
Welders
Heating units
Rail - baggage trucks
Well drilling units
Total:
Loaders
Refrigerator units
Round to the nearest whole gallon.
Schedule C
- Computation of net refund
1.
Opening inventory: Enter the number of gallons of fuel in inventory at beginning of claim period.
1.
2.
Purchases: Enter the total from Schedule A.
2.
3.
Total gallons available: Add Line 1 and Line 2.
3.
4.
Closing inventory: Enter the gallons of fuel in inventory at end of claim period.
4.
5.
Total gallons used: Subtract Line 4 from Line 3.
5.
6.
Nontaxable use: Enter the total from Schedule B.
6.
7.
Taxable use: Subtract Line 6 from Line 5.
7.
8.
Gross refund: Multiply Line 6 by appropriate refund rate per gallon. See Refund Rates on reverse.
8. $
00
9.
Total amount paid: Enter total amount paid for gallons reported on Schedule A.
9. $
10.
Average price per gallon: Divide Line 9 by Line 2.
10. $
11.
Connecticut motor vehicle fuels tax refund rate: See Refund Rates on reverse.
11. $
0.
12.
Net average price per gallon: Subtract Line 11 from Line 10.
12. $
13.
Amount subject to use tax: Multiply Line 12 by Line 6.
13. $
14.
Use tax due: Multiply Line 13 by
.0635
14. $
00
15.
Net refund: Subtract Line 14 from Line 8.
15. $
00
Declaration: I declare under penalty of law that I have examined this return (including any accompanying schedules and statements) and, to the best of my knowledge and belief, it is
true, complete, and correct. I understand the penalty for willfully delivering a false return or document to DRS is a fi ne of not more than $5,000, imprisonment for not more than fi ve years,
or both. The declaration of a paid preparer other than the taxpayer is based on all information of which the preparer has any knowledge.
Taxpayer signature
Title
Date
Print taxpayer’s name
Telephone number
Email address
(
)
Print preparer’s name
Preparer’s SSN or PTIN
Email address
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