Fillable Form Ga-110lmp - Claim For Refund (Page 2 of 2) in pdf

Instructions for form ga-110lmP

Please note:

In order to complete this form, you will first need to obtain the current gasoline, gasohol, or fuel tax rate(s) from Departmental Notice

#12. You may review Departmental Notice # 12 on our web site at:

or by calling the Department at: (317) 232-2339.

The following instructions are to assist you in completing Form GA-110LMP. The instructions are valid for this form only.

line 1. Total gallons Purchased for Exempt use - Enter the total number of gallons purchased for exempt use. You must attach an

original Form STR-100 (Certification of Exempt Purchases of Gasoline & Special Fuel) or copies of each gasoline receipt.

line 2. Total Purchase Price - Enter the total amount paid for the gallons purchased on Line 1.

line 3. Current Rate - Locate the rate from Departmental Notice #12. If you do not have this Notice, you will need to obtain one

before you can proceed. Enter the rate on Line 3.

line 4. Total State and federal Excise Tax - Enter the amount of state and federal excise tax included in sales. Multiply Line 1 by

the rate on Line 3. And enter the amount on Line 4.

line 5. Taxable amount - Subtract the amount on Line 4 from the amount on Line 2 and enter the difference on Line 5.

line 6. Total Sales Tax Paid on fuel used for Exempt Purposes - Calculate the amount on Line 6 by using the chart below. Either

multiply or divide the amount on Line 5 and enter the amount on Line 6. This will be the amount being claimed as a refund.

Chart to Calculate line 6

Dates

How to Calculate

1999 through 11/30/02

Divide the amount(s) on Line 5 by 21

12/01/02 through 03/31/08

Multiply Line 5 by 5.66% (.0566)

04/01/08 forward

Multiply Line 5 by 6.54% (.0654)

Please note:

If you are filing using different periods of time and rates for gasoline and sales, you must complete a different form for each

period.

Taxpayer Representatives must have a valid POA-1 (Power of Attorney Form) on file with the Department. If you do not have a

POA-1 form, you may obtain one from our web site

at:

If you have questions or need assistance please call (317) 232-2339, or you may send an e-mail through our web site by accessing:

Additional GA-110LMP forms may be requested by calling our Form Order Line at (317) 615-2581, leaving the order on our voice mail.

Or, download a GA-110LMP by visiting:

Mail completed form to:

Indiana Department of Revenue

Tax administration / Support, mail Stop #105

100 N. Senate avenue, Room N203

Indianapolis, IN 46204

Retain a copy of the completed form for your records.

Form Ga-110lmp - Claim For Refund Page 2