Form Mf-001 - Fuel Tax Refund Claim Page 2
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4Section 6 – Use Tax Due on Motor Fuel Purchases
(Non Agricultural Off-Road Claimants Only)
1 Check if exempt from paying Wisconsin Use Tax (if not exempt, skip to line 2) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Reason for exemption (see instructions)
If exempt from use tax skip to Section 7.
2 Check if you received a Federal Motor Fuel Tax refund for these purchases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(d)
(f)
(b)
(c)
(e)
(g)
(a)
Number of Gallons
Total Purchase
Refund Amount
Federal
Amount Subject
Fuel Type
Federal
Listed in
for which a
Price of Gallons
Tax
to Use Tax
Fuel Tax
Section 4, Column f
Listed in
Federal Refund
Rate
by Fuel Type
Refunded
(Column b-c-f)
Section 4, Column d
was Received
(column d x e)
3
Gasoline
0.184
4
Clear Diesel
0.244
5
CNG (Compressed Natural Gas)
LNG (Liquified Natural Gas)
6
LPG (Liquified Petroleum Gas)
7
8
Total amount subject to Wisconsin Use Tax (sum of Lines 3 through 7, Column g)
9
Enter applicable Use Tax Rate from Table 1 (see instructions)
10
Wisconsin Use Tax Due (Line 8 multiplied by Line 9), also enter on Line 7, Section 4
Section 7 – Agricultural and Nonagricultural Users - Equipment Schedule
• EQUIPMENT TYPE in which motor vehicle fuel was used for off-road purposes (attach additional sheets if necessary).
(a)
(b)
(c)
(d)
(e)
(f)
Equipment
Manufacturer
Fuel Type
Gallons
Allowable Percent
Refund
Type
Name
Used
(see instructions)
Gallons
(gas, clear diesel,
CNG, LNG, LPG)
(Column d x e)
Total Gallons must equal total gallons entered in Section 4, on Line 6, Column d ►
MF-001 (R. 10-13)
-2-
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