Fillable Form Gt-9 - Gasoline Refund Application printable pdf download

Form GT-9

Rev. 7/13

Gasoline Refund Application

Massachusetts

Gasoline Excise, MGL Ch. 64A

Department of

Revenue

(for transactions occurring before July 31, 2013)

Claim must be filed within two years of the date of purchase. Attach original sales receipts. Application must be filled out in its entirety.

Mail to: Massachusetts Department of Revenue, PO Box 7012, Boston, MA 02204.

Name of applicant

FID or Social Security number

Telephone number

Address

City/town

State

Zip

Note: All International Fuel Tax Agreement (IFTA) motor carrier licensees are required to remit copies of their quarterly IFTA reports

for the periods listed below with this application.

Tax Refund Computation.

First in/first out basis must be used. Fuel should be entered as whole gallons.

Jan.–Mar.

Apr.– June

Jul.–Sep.

Oct.–Dec.

11. Gallons of gasoline on hand at beginning of each period . . . . . . . . . . . . . . . 1

12. Gasoline purchased each period . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

13. Add lines 1 and 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

14. Gasoline on hand at close of business of each period . . . . . . . . . . . . . . . . . 4

15. Subtract line 4 from line 3. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

16. Gasoline used for the propulsion of vehicles registered for highway use . . . 6

17. Gasoline sold . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

18. Gasoline unaccounted for . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

19. Gasoline used on which a refund is claimed . . . . . . . . . . . . . . . . . . . . . . . . . 9

10. Tax rate per gallon . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

.21

11. Amount of excise refund. Multiply line 9 by line 10 . . . . . . . . . . . . . . . . . . . 11

Adjustment for use tax

12. Cost of gasoline reported in line 9. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

13. Enter amounts from line 11 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

14. Amount subject to use tax. Subtract line 13 from line 12 . . . . . . . . . . . . . . 14

15. Use tax. Effective August 1, 2009, the use tax rate changed from 5% to 6.25%. See Example 2 in TIR 09-12 for reporting rules

for quarterly filers after rate changes in the sales/use taxes. Multiply line 14

by applicable tax rate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

16. Amount to be refunded each period. Subtract line 15 from line 11. . . . . . . 16

17. Total amount to be refunded. Add line 16, col’s. a, b, c and d . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

Supplier’s name, address, and date of purchase must be on each sales receipt. Sales receipts will be returned if a written request

accompanies the application. Application subject to audit. Complete records must be kept three years for verification by a represent -

ative of the Commissioner. If there is any evidence of erasures or changes in either dates or amounts shown on sales receipts, appli -

cation will be disallowed in its entirety. Answer all questions on reverse or application will be disallowed. Claims based on

estimates are not acceptable.

The undersigned applicant states under the penalties of perjury that all information contained in this application is true,

correct and complete and that the undersigned has complied with all laws of the Commonwealth relating to taxes.

Signature of applicant or person authorized to sign

Date

This form approved by the Commissioner of Revenue.

printed on recycled paper

Form Gt-9 - Gasoline Refund Application

Related Articles

Related forms

Related Categories