Form Ref-1000 - Claim For Fuel Tax Refund
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3Form REF-1000
Indiana Department of Revenue
Mailing/Contact Information:
Indiana Department of Revenue
State Form 50854
Claim for Fuel Tax Refund
(R7 / 5-17)
Special Tax Division
P.O. Box 1971
Indianapolis, IN 46206-1971
(317) 615-2630
fetax@dor.in.gov
Section A: Information
Individual or Business Name
Social Security Number or Federal Identification Number
Street Address
Indiana Taxpayer Identification Number
City, State and ZIP Code
Refund Period
Telephone Number
Email Address
Use of Fuel (Only Check One):
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A – Agriculture
E – Local Transit Systems
I – Mining
M – Other (Specify)
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B – Aviation
F – Maintenance
J – Railroad
______________________________
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C – Building/Construction
G – Manufacturing
K – Refrigeration
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D – Export
H – Marine
L – Taxicabs
Section B: Refund Computation
You may use only one gas tax rate and special fuel tax rate per claim
Gasoline
Special Fuel
form.
(Use Whole Gallons)
(Use Whole Gallons)
1. Beginning Inventory
2. Total Purchases
3. Total Available Gallons (Line 1 plus Line 2)
4. Gallons Used for Taxable Purposes
5. Gallons Used for Exempt Purposes (From Section C, Line 11)
6. Ending Inventory (Line 3 minus Line 4 minus Line 5)
7. Proportional Gallons Eligible for Refund (From Section D, Line 6)
8. Total Gallons Eligible for Refund (Line 5 plus Line 7)
9. Fuel Tax Rate (See table below)
10. Fuel Tax Refund (Line 8 multiplied by Line 9)
11. Collection Allowance Adjustment
12. Total Amount of Refund (Line 10 minus Line 11)
13. Surcharge Tax Rate (See table below)
14. Surcharge Tax Refund (Line 8 multiplied by Line 13)
15. Total Amount of Refund (Line 12 plus Line 14)
Fuel Tax Rate Table
Surcharge Tax Rate Table
Refund Tax Period
Gasoline Tax Rate
Special Fuel
Refund Tax Period
Surcharge Tax Rate
Tax Rate
Prior to July 1, 2017
Not Applicable
Prior to July 1, 2017
$0.18
$0.16
On or after July 1, 2017
$0.21 per gallon
On or after July 1, 2017
$0.28
$0.26
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Parent category: Financial