Form 84 - Nebraska Non-Ag Use Motor Fuels Tax Refund Claim Page 2
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3INSTRUCTIONS
CAUTION: Only federal governmental agencies and buses for hire are eligible for the refund of tax on fuel
placed into a licensed motor vehicle. All other users of fuel in licensed motor vehicles, regardless of how
those vehicles are used, are not eligible for a refund of motor fuels tax.
NOTE: All refund claims are subject to audit for three years after the claim is filed.
WHO MAY FILE. Any person requesting a refund of Nebraska motor fuels tax paid or overpaid may file a Nebraska
Non-Ag Use Motor Fuels Tax Refund Claim, Form 84. Prior to adjustments, the tax paid on the eligible fuel must
be at least $25. This minimum must be met within a calendar year for each fuel type. Refunds of the Petroleum
Release Remedial Action Fee must meet a $10 minimum.
WHEN TO FILE. Only one claim per month may be filed by any claimant. You must file your claim within three
years from the date of payment of the tax. Claims filed for refunds of tax paid on aviation jet fuel or aviation gasoline
used in the operation of a FAA-approved air school must be filed within seven months of the date of purchase.
WHERE TO FILE. This claim, along with supporting documentation, must be filed with the Nebraska Department
of Revenue, Motor Fuels Division, PO Box 98904, Lincoln, NE 68509-8904.
BASIS FOR CLAIM. Appropriate documentation must be attached to the Form 84. Documentation submitted
with the Form 84 will not be returned.
Exempt Use of Tax-Paid Undyed Diesel, Gasoline, Gasohol, and Ethanol. Any person who
has purchased and used tax-paid motor fuel for a qualified exempt purpose may file a claim.
Required documentation. In order to support the claim, the following information must be included:
•
A description of your operations must be submitted with the initial claim, and then
on an annual basis;
•
A list of the type of equipment in which the fuel was used must be submitted with the
initial claim, and then on an annual basis; include the make, horsepower, and other
mechanical description of the machinery;
•
Information regarding the fuel purchase usage and storage;
•
Legible copies of fuel purchase invoices indicating the amount of tax paid, the date
of purchase, fuel type, gallons purchased, and vendor’s name. If the fuel was placed
directly into unlicensed equipment, the equipment fueled must be indicated on the
invoice; and
•
Legible copies of withdrawal logs documenting the date, gallons, and equipment into
which the fuel was placed if both licensed vehicles and unlicensed equipment are
fueled from the same storage facility (refer to the
Nebraska Motor Fuels Tax Refunds
Information Guide
for additional information).
Exports of Tax-Paid Fuel, Including the Petroleum Release Remedial Action Fee. Generally,
a person is required to be licensed as an exporter prior to exporting fuel. Any person who is not required
to be licensed, who owned and exported fuel upon which Nebraska motor fuels tax was previously paid,
may file a claim.
Required documentation. In order to support the claim, the following information must be included:
•
Legible copies of invoices or other supporting records that indicate the taxes and fees
were paid to a motor fuel licensee;
•
The state to which the fuel was exported; and
•
Copies of the returns filed indicating that the fuel was reported to those states.
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