Form L-304 - Application For Farm Gasoline User Fee Refund
ADVERTISEMENT
1
2STATE OF SOUTH CAROLINA
1350
DEPARTMENT OF REVENUE
L-304
APPLICATION FOR
(Rev. 10/1/14)
FARM GASOLINE USER FEE REFUND
4011
Mail to: South Carolina Department of Revenue, Motor Fuel, Columbia, SC 29214-0139
By Email: motfuellic@dor.sc.gov
Telephone: (803) 896-1990
IMPORTANT
Name and Address
ALWAYS REFER TO THE
FILE
NUMBER
WHEN
WRITING THE DIVISION
FILE NUMBER
SSN/FEIN
Email Address
All invoices must be made out the same as the name listed above. This application must be accompanied by a
true copy of the invoice. The claim must be filed not more than 3 years after the date of the invoice
The said gasoline was purchased by me as enumerated below and as set forth on the purchase invoice(s) attached. The
amount of gasoline which has been used is shown on the reverse side.
RECORD OF REFUND GASOLINE PURCHASED
Date of
Invoice
Gallons
Purchases
Number
Name of Licensed Distributor
Purchased
Total gallons gasoline purchased .......................................................................................................
COMPUTATION OF USER FEE REFUND
DO NOT USE THIS SPACE
Number gallons used ..................................
Amount of refund per gallon ........................
$
Amount of refund approved ....................... $
Total amount of refund due .........................
$
Audited by
Date
Interest ........................................................
$
Approved by
Date
(Over)
40111023
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Financial