Form Mf-220 - Credit/refund Request E-85 Inventory January 1, 2007

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KANSAS DEPARTMENT OF REVENUE
CUSTOMER RELATIONS
915 SW Harrison St.
Topeka, Kansas 66625-8000
Phone Number: (785) 368-8222
Fax: (785) 296-4993
CREDIT/REFUND REQUEST
E-85 INVENTORY JANUARY 1, 2007
Please check the box that applies:
Licensed Motor Vehicle Fuel and Special Fuel
Distributor. License #
Licensed Motor Vehicle Fuel and Special Fuel
Importer/Exporter. License #
Licensed Motor Fuel Retailer.
License #
Pursuant to 2006 Senate Bill 544 the motor-vehicle fuels tax rate on E-85 will be reduced to $.17 per gallon effective January 1, 2007.
To qualify for a motor-vehicle fuel tax credit/refund of $.07 per gallon, all information below must be provided. The credit/refund is
calculated on the number of gallons of E-85 in inventory on January 1, 2007 and which, the Kansas motor-vehicle fuel tax of $.24 per
gallon was previously paid. The credit/refund request is due January 25, 2007.
FACILITY OR
LOCATION ADDRESS
E-85 GALLONS
TOTAL TAX
LOCATION #
INVENTORY 1
/1/
07
FOR CREDIT/REFUND
TOTAL CREDIT REFUND
/
I declare under the penalties of perjury that to the best of my knowledge this is a true, accurate and complete request.
Signature
Title
Date
Telephone Number
MF-220 (Dec/06)

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