Form Mf-015 - Claim For General Aviation Petroleum Inspection Fee Refund - 2012 Page 2
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2MF-015 INSTRUCTIONS
WHO MAY FILE THIS CLAIM
Line 4 - Enter the mailing address of the busi-
ness.
This form may be filed by anyone who purchases
general aviation fuel in Wisconsin from suppli-
Line 5 - Check box 1, 2, 3, 4 or 5 as applicable.
ers in excess of one million gallons during a
Also enter the incorporation date if box 3 or 4
calendar month. The term “supplier” is defined
are checked.
in secs. 78.005(14) and 168.01(2), Wis. Stats.
Line 6 - Check either yes or no.
The allowance may not be claimed if general
aviation fuel is purchased for resale. The al-
Line 7 - Enter the requested information for each
lowance is paid from the petroleum inspection
supplier. Attach additional sheets as needed.
fee
(2¢ per gallon) collected by the department.
Line 8 - Enter the total for line 7 from all sheets.
INVOICES
Attach copies of invoices verifying the fuel pur-
Line 10 - Enter the amount of line 8 minus Line 9.
chases itemized on line 7. Do not send original
invoices as they will not be returned to you.
Line 12 - Enter amount of Line 10 multiplied by
line 11.
DUE DATE
Refund claims must be filed within 12 months of
Enter your name, daytime phone number, date
and sign the form.
the date the general aviation fuel is purchased.
Each claim is limited to fuel purchased during
ASSISTANCE
one calendar month.
You can access the department’s web site at
PENALTIES
From this web site, you can:
Wisconsin law imposes penalties and interest
• Complete electronic fill-in forms
when an inaccurate refund claim is negligently or
• Download forms, schedules, instructions, and
fraudulently filed. Persons who knowingly sign
publications
or assist in the preparation of a fraudulent claim
• View answers to commonly asked questions
may be fined not more than $500 or imprisoned
• E-mail for assistance
not more than 30 days or both. Altering a pur-
• Access My Tax Account
chase date on an invoice to bring it within the 12
month filing period is a fraudulent act.
Madison Office Location
2135 Rimrock Road
INSTRUCTIONS
Madison WI 53713
Box 1 - Enter the legal name of the Business.
Mailing Address
Box 2 - Enter the Federal Employee Identifi-
Excise Tax Section 6-107
Wisconsin Department of Revenue
cation Number (FEIN) or the Social Security
PO Box 8900
Number (SSN) for the business.
Madison WI 53708-8900
Line 3
• Enter the Business Name, Doing Business As
Phone: (608) 266-3223 or (608) 266-0064
Fax: (608) 261-7049
(DBA) if different then item 1.
• Enter the business phone number, to include
E-mail: excise@revenue.wi.gov
the area code.
• Enter the Wisconsin county in which the busi-
ness is physically located.
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Parent category: Financial