Form Dr-309660 - Application For Pollutants Tax Refund - 2013 Page 2
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6DR-309660
Florida Department of Revenue
R. 01/13
Application for Pollutants Tax Refund
Page 2
Coastal Protection
Water Quality
Inland Protection
Schedule A. Tax-paid petroleum bunkered in a vessel or exported
1. Beginning Inventory (Must agree with closing inventory from prior quarter)
2. Purchases (From completed Schedule 1 – Schedule of Purchases)
3. Ending inventory (Use this figure for beginning inventory on next claim)
4. Barrels consumed ( Add Lines 1 and 2. Subtract Line 3)
5. Barrels not eligible for refund
6. Barrels claimed for refund (Line 4 minus Line 5 )
7. Refund (Line 6 multiplied by the rate per barrel)
$
$
$
Schedule B. Tax-paid motor oil and lubricants bunkered in a vessel or exported
8. Beginning Inventory (Must agree with closing inventory from prior quarter)
9. Purchases (From Schedule 1- Schedule of Purchases)
10. Ending inventory (Use this figure for beginning inventory on next claim)
11. Gallons consumed ( Add Lines 8 plus 9. Subtract Line 10)
12. Gallons not eligible for refund
13. Gallons claimed for refund (Line 11 minus Line 12)
14. Refund (Line 13 multiplied by rate per gallon)
$
$
$
Schedule C. Tax-paid pollutant exported from the state by a licensee
15. Beginning Inventory (Must agree with closing inventory from prior quarter)
16. Purchases (From Schedule 1- Schedule of Purchases)
17. Ending inventory (Use this figure for beginning inventory on next claim)
18. Barrels consumed ( Add Lines 15 plus 16. Subtract Line 17)
19. Barrels not eligible for refund
20. Barrels claimed for refund (Line 18 minus Line 19)
21. Refund (Line 20 multiplied by rate per barrel)
$
$
$
Schedule D. Solvents
22. Beginning Inventory (Must agree with closing inventory from prior quarter)
23. Purchases (From Schedule 1-Schedule of Purchases)
24. Ending inventory (Use this figure for beginning inventory on next claim)
25. Gallons consumed ( Add Lines 22 plus 23. Subtract Line 24)
26. Gallons not eligible for refund
27. Gallons claimed for refund (Line 25 minus Line 26)
28. Refund (Line 27 multiplied by rate per gallon)
$
$
$
29. Total net refund requested (Add Lines 7 plus 14 plus 21 and Line 28)
$
30. Less refund processing fee
$
-2.00
31. Net refund due (Line 30 minus Line 31)
$
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