Form Ref-1000 - Claim For Fuel Tax Refund Page 2
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3Section C: Exempt Use Details
1. Vehicle or
2. Make and
3. Licensed with
4. Description of Use
5. Exempt Gallons Used
Equipment
Model
the BMV
(Whole Gallons)
Type
Gasoline
Special Fuel
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□
Yes
No
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Yes
No
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Yes
No
□
□
Yes
No
□
□
Yes
No
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□
Yes
No
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□
Yes
No
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□
Yes
No
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□
Yes
No
□
□
Yes
No
□
□
Yes
No
□
□
Yes
No
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□
Yes
No
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Yes
No
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Yes
No
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Yes
No
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Yes
No
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Yes
No
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Yes
No
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Yes
No
6. Subtotal
7. Tax-Paid Gallons Used to Denature Alcohol
8. Tax-Paid Gallons Exported to Another State
9. Tax-Paid Gallons Used in a Motorboat on Lake Michigan or the Ohio River
10. Tax-Paid Gallons Sold to the U.S. Government
11. Total to Report in Section B, Line 5 (Line 6 plus Line 7 plus Line 8 plus Line 9 plus Line 10)
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