Form Dr-309639 - Application For Refund Of Tax Paid On Undyed Diesel Used For Off-Road Or Other Exempt Purposes Page 2

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DR-309639
R. 01/13
Page 2
Name
FEIN
Category:
Please Check All Applicable Boxes: Note: This application can be used for more than one category of refund.
q D
q A
Fuel used in off-road stationary equipment or for
Fuel used to turn a concrete mixer drum or to compact solid waste.
commercial cooking and heating. (The eligible
q B
Fuel used for unloading bulk cargo by pumping.
equipment must have a separate fuel supply
system other than the one that propels the
q C
Fuel used to propel off-road diesel equipment.
vehicle.)
Part I:
1) Beginning Inventory (Measured on the first day of the refund period)
1.
gals.
2) Gallons Purchased (From completed Schedule 1A-Schedule of Purchases)
2.
gals.
3) Ending Inventory (Measured on the last day of the refund period)
3.
gals.
4) Gallons to be Accounted for (Lines 1 plus 2 minus 3)
4.
gals.
5) Gallons Consumed in Trucks (For A and B users only)
a. Concrete Mixers/Solid Waste Compactors 5a.
gals.
Unloading by Pumping
gals.
b.
(From completed Schedule ID, Part II)
5b.
6) Gallons Consumed for Other Exempt Off-road Purposes (for C and D users only)
c. To Propel Off-road Equipment
6c.
gals.
d. Off-road Stationary Equipment
6d.
gals.
7) Gallons Consumed for Highway Use (Line 4 minus Lines 5a, 5b, 6c, and 6d)
7.
gals.
Part II:
Calculation of Refund Due Based on Categories Above:
A. Refund on Undyed Diesel Fuel Consumed by Concrete Mixers/Solid Waste Compactors:
8) Gallons Eligible for Refund (35% of Part 1, Line 5a)
8.
gals.
9) Line 8 multiplied by Average Cost per Gallon (From Schedule 1B, see instructions)
9. $
10) Fuel Tax Eligible for Refund (Line 8 multiplied by $.318)
10. $
11) Sales Tax Due [Line 9 multiplied by (6% plus applicable surtax – see Schedule 1C)] 11. $
12) Net Refund Due (Line 10 minus Line 11)
12. $
B. Refund on Undyed Diesel Fuel Consumed for Unloading Bulk Cargo by Pumping:
8) Gallons Eligible for Refund (Part I, Line 5b)
8.
gals.
9) Line 8 multiplied by the Average Cost per Gallon (From Schedule 1B, see instructions) 9.
10) Fuel Tax Eligible for Refund (Line 8 multiplied by $.318)
10. $
11) Sales Tax Due [Line 9 multiplied by (6% plus applicable surtax – see Schedule 1C) 11. $
12) Net Refund Due (Line 10 minus Line 11)
12. $
C. Refund on Undyed Diesel Fuel Used to Propel Off-road Equipment:
8) Gallons Eligible for Refund (Part I, Line 6c)
8.
gals.
9) Line 8 multiplied by the Average Cost per Gallon (From Schedule 1B, see instructions) 9. $
10) Fuel Tax Eligible for Refund (Line 8 multiplied by $.318)
10. $
11) Sales Tax Due [Line 9 multiplied by (6% plus applicable surtax – see Schedule 1C)] 11. $
12) Net Refund Due (Line 10 minus Line 11)
12. $
D. Refund on Undyed Diesel Fuel Used in Off-road Stationary Equipment or for Commercial Cooking and Heating:
gals.
8) Gallons Eligible for Refund (Part I, Line 6d)
8.
9) Line 8 multiplied by the Average Cost per Gallon (From Schedule 1B, see instructions) 9. $
10) Fuel Tax Eligible for Refund (Line 8 multiplied by $.318)
10. $
11) Sales Tax Due [Line 9 multiplied by (6% plus applicable surtax – see Schedule 1C)] 11. $
12) Net Refund Due (Line 10 minus Line 11)
12. $
Total Net Refund Requested (Sum of applicable Line 12 totals
13)
for Sections A, B, C, D. Carry forward to Page 1, Line 13)
13. $
Note: Total gallons eligible for refund cannot exceed Part I, Line 4 (Gallons to be Accounted for).

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