Form Mvf-81 - Ohio Motor Fuel Tax Refund Claim For School Districts
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MVF-81
Rev. 8/05
P.O. Box 530
Columbus, OH 43216-0530
Ohio Motor Fuel Tax Refund Claim for School Districts
Period
to
(must be fi led within 365 days)
Permit number
Name
Address
City
State
ZIP
1. Total gallons of tax-paid motor vehicle fuel purchased during the period (see instructions) .........
2. Total gallons of tax-paid motor vehicle fuel sold to others during the period .................................
3. Total gallons of tax-paid motor vehicle fuel purchased for school district or Educational
Service Center operations (line 1 minus line 2) ............................................................................
4. Total refund requested (line 3 multiplied by tax rate
– see instructions) ......................... $
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
Telephone
Date
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. Contact the Motor Fuel Tax Refund Unit at (855) 466-3921 with any questions or go to our
website (tax.ohio.gov). Claimant must retain a copy of this claim and all pertinent supporting documents.
Instructions
Note: No refund shall be authorized under Ohio Revised
the number of gallons purchased and the purchase
Code Section 5735.142 for any single refund claim for
price, must be submitted with this claim.
less than 100 gallons.
Line 2 Fuel sold to others: Enter the total number of
Period covered by the claim: Enter both the beginning and
gallons of tax-paid motor vehicle fuel (included in
ending dates covered by this claim. The claim must be fi led
line 1) that was sold from bulk storage to others.
within 365 days from the date of fuel purchase.
Line 3 Total refundable gallons purchased: Line 1 minus
Line 1 Fuel purchased: Enter the total number of gallons
line 2.
of tax-paid motor vehicle fuel purchased for school
Line 4 Refund: Enter the net amount of this claim, which
district or Educational Service Center operations
is line 3 multiplied by the refundable rate per gallon
during the period covered by this claim. Evidence of
as shown below:
fuel purchase, such as fuel invoices, cash receipts,
credit card receipts or any other document that
July 1, 2003 to June 30, 2004
$0.02
contains the name and address of the seller, name
July 1, 2004 to June 30, 2005
$0.04
of the purchaser, date of purchase, type of fuel,
July 1, 2005 and after
$0.06
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