MVF 9
Rev. 8/05
P.O. Box 530
Columbus, OH 43216-0530
Ohio Motor Fuel Tax Refund Claim for Transit Buses
Name
Permit #
Address
City
State
ZIP
Period covered by claim
to
Inventory
1. Opening (physical) inventory tax-paid motor vehicle fuel ...........................................................
2. Total gallons tax-paid motor vehicle fuel purchased during the period shown on the
accompanying invoices or receipts (see instructions) .................................................................
3. Closing (physical) inventory tax-paid motor vehicle fuel .............................................................
4. Total gallons tax-paid motor vehicle fuel available (line 1 plus line 2 minus line 3) ....................
Usage
5. Total gallons tax-paid motor vehicle fuel sold to others ..............................................................
6. Total gallons tax-paid motor vehicle fuel consumed in vehicles other than qualifi ed transit
buses ..........................................................................................................................................
7. Total gallons tax-paid motor vehicle fuel consumed in transit buses while operating in a
nonqualifying manner (see instructions) .....................................................................................
8. Total gallons tax-paid motor vehicle fuel consumed off the public highways of this state (attach
schedule of usage)
@ applicable tax rate ............................................................ $
9. Total gallons tax-paid motor vehicle fuel consumed in a refundable manner by qualifi ed transit
buses (attach schedule of usage – see instructions)
@ applicable tax rate ......... $
10. Total refund requested (line 8 plus line 9) ................................................................................... $
I declare under penalties of perjury that this claim (including any accompanying schedules and statements) has been examined
by me and to the best of my knowledge and belief is true, correct and complete.
Signature
Title
Date
Telephone
The original claim should be submitted to the Ohio Department of Taxation, Motor Fuel Tax Refund Unit, P.O. Box 530,
Columbus, Ohio 43216-0530. Direct any questions to (855) 466-3921. Claimant must retain a copy of this claim and all
pertinent supporting documents.