Form 72a053-A - Application For Refund Of Kentucky Motor Fuel Tax Paid On Nonhighway Motor Fuels (Krs 138.344 Through 138.355) Page 2

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INSTRUCTIONS
This application shall be filed by Kentucky motor fuels tax refund permit holders on a calendar quarter
or calendar year basis. Attach the original invoices issued by the licensed special fuels or gasoline
dealer to this application. These invoices must reflect the itemized tax and fees charged. Use this form
to apply for a refund of the Motor Fuels Tax and Petroleum Environmental Assurance Fee. A separate
check will be issued for the fee refund.
IMPORTANT INFORMATION
• Purchases made prior to the effective date of the Kentucky motor fuels tax refund permit are not
refundable.
• Purchases from retail filling stations do not qualify for refund.
CONTACT THE FOLLOWING
For Forms, Information and Assistance ➤ ➤ ➤ ➤ ➤ Motor Fuels Tax Compliance Section
(502) 564-3853

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