Form Ft-946/1046 - Motor/diesel Motor Fuel Tax Refund Application

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New York State Department of Taxation and Finance
FT-946/1046
Motor/Diesel Motor Fuel Tax Refund Application
(6/13)
Motor fuel tax (gasoline)
Diesel motor fuel tax
Both
For office use only
Line 9 gallons
Do not use for refund claims of sales and use tax or petroleum business tax.
x $.064 = $
Read instructions in Form FT-946/1046-I carefully.
Beginning
Ending
Filing
Line 10 gallons
period:
x $.08 = $
Name of claimant
Telephone number
Total refunds $
(
)
Street address
City
State
ZIP code
Audited by:
Date:
Approved by:
Date:
Social security number
NYS identification number
Federal employer identification number (EIN)
Approved by:
Date:
Refund claimed
Total refund claimed
...................................................................................................................
$
(from line 13 on page 2)
Basis for refund
Mark an X in this box if you are filing multiple claims for refunds of motor/diesel motor fuel tax, sales tax, or petroleum business tax for the same period and
gallonage. You must file this form and the appropriate sales tax refund claim form and/or petroleum business tax refund claim form together. Attach invoices
or other substantiation as required by all forms and mail all forms in one envelope.
Mark an X in the box under section A, B, C, or D that indicates your type of operation and enter any other requested information.
A — Nontaxable use
(off highway)
D — Specific organizations entitled to reimbursement
Farmer - number of acres under cultivation
Voluntary ambulance service
Industrial type
Volunteer rescue squad
Contractor - job location
Volunteer fire company/department
Vehicles on rails or tracks
Nonpublic school operator
Commercial boats
Exempt hospital (number)
Aircraft
New York State and its municipalities
Refrigerator (reefer) unit
United States and any of its agencies or instrumentalities
Other
(explain)
Indian tribe or nation
Member of exempt Indian tribe or nation – I hereby certify that I,
, am an enrolled member of
B — Refund assignment
the exempt Indian tribe or nation of
,
and that the fuel for which this refund is claimed was delivered
Used by snowmobile club members (motor fuel)
to me on the
reservation.
Other
(explain)
C — Nontaxable sales
To New York State and its municipalities
To the United States and any of its agencies or instrumentalities
To airlines (kero-jet fuel)
For heating purposes (diesel motor fuel)
To exempt hospitals (motor fuel)
For immediate export (motor fuel)
Sales of E85 to filling stations on or after September 1, 2006
For the motor vehicles or equipment you own, indicate how many of each type that uses motor fuel (MF) or diesel motor fuel (DMF). If you do not own any
of the following types of equipment, enter N/A in the box where indicated. If the fuel was used in a commercial motor boat, airplane, snowmobile, or all-terrain
vehicle (ATV), list the type of fuel and registration number(s), if applicable, where indicated. Attach additional sheets if necessary.
On-road
MF
DMF
Off-road
MF
DMF
Commercial motor boat, airplane, snowmobile, or ATV registration number
vehicles
equipment
Automobiles
Motor boats
Trucks
Airplanes
Tractors
Snowmobiles/ATV
Indicate the types
of other machinery.
Other
Pumps/Other

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