Form Dmf-80 - Reimbursement Request For Motor Fuel Taxes Paid On Sales To Government/exempt Entities Page 2
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2Instructions for completing Form DMF-80, Reimbursement Request
for Motor Fuel Taxes Paid on Sales to Government/Exempt Entities
General Information:
Reimbursements are provided in accordance with Chapter 90 of the Pennsylvania Vehicle Code, Liquid
Fuels and Fuels Tax.
Non-permitted Dealers/Retailers are persons other than Pennsylvania registered distributors who
sell motor fuels (i.e. gasoline, gasohol, undyed diesel fuel and/or undyed kerosene).
Pennsylvania Registered Distributor is a person licensed under Section 9003 of the Liquid Fuels
and Fuels Tax Act.
Assignment of Rights – Liquid Fuels and Fuels Tax Refund (Form REV-568) must be
provided for each governmental or exempt entity listed in Section 2, Reimbursement Information,
on the front of this form. The period indicated on the Assignment of Rights form must coincide with
the refund period indicated on the front of this form.
Liquid Fuels and Fuels Tax Rate Information:
Tax Period:
Gasoline
Diesel
01/01/2009 through 12/31/2009
$ 0.312
$ 0.381
01/01/2010 through 12/31/2010
0.312
0.381
01/01/2011 through 12/31/2011
0.312
0.381
01/01/2012 through 12/31/2012
0.312
0.381
01/01/2013 through 12/31/2013
0.312
0.381
Section 1. Application Information – Provide the name, address and identification information for
the party requesting the motor fuels tax reimbursement.
Section 2. Reimbursement Information – Provide in Part A the period covered in the
reimbursement request. Show beginning and ending periods by indicating month, day and year. In Part
B, Lines 1 through 20, provide the names of the governmental or exempt entities to which motor fuel
was sold tax-free, the gallons of gasoline sold and the gallons of undyed diesel fuel sold, then cal-
culate refund amounts for gasoline and diesel fuels sold. Use the above tax rates to calculate
refund amounts. On Line 21, provide totals. In Part C, total the gasoline and diesel refund amounts.
This is the total reimbursement requested for the refund period indicated.
Section 3. Certification – Read the certification statement and provide the name, signature and title
of the person making the reimbursement request. Please also date the request.
Non-permitted dealers/retailers may petition for reimbursement on a quarterly, semi-annual or annual
basis. The department will also consider monthly petitions in cases where tax reimbursements exceed
$500.
Taxpayers with questions should contact the Bureau of Motor and Alternative Fuels Taxes
at the address or phone number on the front of this form.
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