Form Dr-160 Draft - Application For Fuel Tax Refund Mass Transit System Users
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1
2
3DR-160
Application for Fuel Tax Refund
R. 01/18
Mass Transit System Users
Rule 12B-5.150
For the Quarter Ending
Florida Administrative Code
Effective 01/18
Check here if amending
Mail To:
Florida Department of Revenue
Refunds
P.O. Box 6490
Tallahassee FL 32314-6490
For Help Call: 850-617-8585
Permit #:
FEIN:
Business Partner #:
Mass transit contract effective dates:
From:
to:
Column A
Column B
Part I – Gasoline, Gasohol
Gallons
and Undyed Diesel Fuel
Gasoline/Gasohol
Undyed Diesel
1. Beginning inventory
(Must agree with
,
,
.
,
,
.
closing inventory from prior quarter) ................
2. Gallons purchased
("Schedule of
,
,
.
,
,
.
Purchases" attached) .......................................
3. Closing inventory
(Use this figure for
,
,
.
,
,
.
beginning inventory on next claim) ..................
4. Total consumption
(Add Lines 1 and 2.
,
,
.
,
,
.
Subtract Line 3) ................................................
5. Gallons not eligible for refund
,
,
.
,
,
.
(Off-road use) ...................................................
6.
Gallons claimed for refund
(Subtract
,
,
.
,
,
.
Line 5 from Line 4) ............................................
$
,
,
.
$
,
,
.
7. Refund
(Lines 6A and 6B X
.1331
) ................
See item nine on reverse page if any of the gallons claimed on Line 6 were purchased during the previous calendar year.
Part II – Local Option Tax and State Comprehensive Enhanced Transportation System (SCETS) Tax
This section to be used by those mass transit systems located in counties levying the local option tax as provided in s. 336.025, Florida Statutes
(F.S.), and the SCETS tax imposed according to s. 206.41(1)(f) or 206.87(1)(d), F.S. Current local option and SCETS tax rates are available
through our Internet site at .
1. Total gallons purchased and used subject to refund
,
,
.
(Must not exceed gallons claimed in Part I, Lines 6A & 6B) ................................................................................
2. Rate of tax levied:
(A)
Gasoline/Gasohol _____________________________Cent(s)
.132
(B)
Undyed Diesel Fuel ____________________________Cent(s)
$
,
,
.
3. Amount of tax claimed for refund
(Lines 6A X 2A + Lines 6B X 2B) .....................................................
Net Refund Due (Add Part I, Line 7(A) and 7(B) and Part II, Line 3)
$
,
,
.
No refund will be issued for less than $5.00.
Under penalty of perjury, I declare that I have read this application and the facts stated in it are true.
____________________________________________
___________________________________________
Signature of Applicant
Contact Person
____________________________________________
__________________________________________
Print/Type Applicant Name
Contact Telephone Number
____________________________________________
__________________________________________
Date
Contact Email address
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