Schedule Mf-72 - Motor Fuel Refund Bulk Fuel Disbursements Schedule Page 2

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K.A.R. 92-3-20 Refunds, books and records.
(a) Each person claiming a refund of motor fuel tax for non-highway usage shall substantiate
the claim with adequate records. An officer, partner, or owner shall verify each return as to the
accuracy of the information included on the return.
Fuel used shall be presumed to be for highway use unless it is accurately
documented for non-highway use.
Company/Individual Information: Enter the Name, Address, City, State, and Zip Code.
Bulk Fuel Tank Information: Enter the Month, Year, Bulk Tank #, Fuel Type, and Refund
Permit #.
Bulk Fuel Disbursement Information: Enter the Date, Tag # or Equipment Description,
Beginning Meter Reading, Gallons used in Highway Vehicles, Gallons used in Non-Highway
Vehicles, Gallons used in Off Road Equipment, and Ending Meter Reading.
Total Gallons: Enter the total gallons disbursed for Gallons used in Highway Vehicles,
Gallons used in Non-Highway Vehicles, and Gallons used in Off Road Equipment. Carry this
information over to your Bulk Fuel Inventory/Reconciliation Schedule.
Example:
BULK FUEL DISBURSEMENT INFORMATION
GALLONS USED
GALLONS
TAG # /
BEGINNING
GALLONS
IN NON-
USED IN OFF
ENDING
DATE
EQUIP
METER
USED IN
HIGHWAY
ROAD
METER
(mm/dd/yy)
DESECRIPTION
READING
HIGHWAY
VEHICLES
EQUIPMENT
READING
VEHICLES
04/03/09
Compressor1
1850.1
11.1
1861.2
04/03/09
ABC123
1861.2
85.8
1947.0
04/04/09
Loader
1947.0
25.3
1972.3
85.8
36.4
TOTALGALLONS:
MF-72 (Rev 05-09)

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