Form Ft-946/1046 - Motor/diesel Motor Fuel Tax Refund Application Page 2
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1
2Page 2 of 2 FT-946/1046 (6/13)
A
B
Enter separately in columns A or B the number of gallons of motor fuel/diesel motor fuel
Motor fuel
Diesel motor fuel
purchased and consumed in New York State on which the excise tax was paid.
1 Beginning physical inventory
(bulk storage only - others enter 0) (If no ending inventory was
shown on the preceding claim, no beginning inventory should be shown on this claim. Beginning
inventory should not include purchases made more than three years prior to date of filing a
1
..............................................................................................................................
claim.)
2 Purchases for this filing period
.......................
2
(do not include purchases over three years old)
3 Gallons available
....................................................................................
3
(add lines 1 and 2)
4 Ending physical inventory
.................................................
4
(bulk storage only - others enter 0)
5 Total gallons used
.......................................................................
5
(subtract line 4 from line 3)
6 Number of taxable gallons used during this filing period
(explain use and type of fuel)
6
7 Nontaxable gallons
......................................................................
7
(subtract line 6 from line 5)
8 Total amount of nontaxable gallons
..................
8
(add the amounts on line 7, columns A and B)
9 Gallons of B20 included in line 8 that were purchased on or after September 1, 2006 .....
9
10 Gallons of fuel other than B20
.................................................... 10
(subtract line 9 from line 8)
11 Refund claimed on B20
................................................................ 11
(multiply line 9 by $0.064)
12 Refund claimed on all other fuel
................................................... 12
(multiply line 10 by $0.08)
13 Total refund claimed
............................................................................ 13
$
(add lines 11 and 12)
Certification: I certify that this is a true, correct, and complete report.
Signature of authorized person
Official title
County
Authorized
person
E-mail address of authorized person
Telephone number
Date
(
)
Firm’s name
Firm’s EIN
Preparer’s PTIN or SSN
(or yours if self-employed)
Paid
preparer
Signature of individual preparing this application
Address
City
State
ZIP code
use
only
E-mail address of individual preparing this application
Telephone number
Preparer’s NYTPRIN
Date
(see instr.)
(
)
See Form FT-946/1046-I, Instructions for Form FT-946/1046, for where to file.
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