Form Dr-185 - Application For Fuel Tax Refund Permit
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1DR-185
R. 01/16
Application for Fuel Tax Refund Permit
TC
Rule 12B-5.150
Florida Administrative Code
Application for year ending December 31, 20___
Effective 01/16
Business name:
Owner’s name:
Mailing address:
City, State, ZIP:
Location address (other than above):
City, State, ZIP:
Business telephone number (include area code):
Fax number including area code (optional):
Federal Employer Identification Number (FEIN) or Social Security Number:
Email address:
Indicate Type of Permit Requested:
School District (see s. 206.41(4)(e), F.S.)
Municipality (see section (s.) 206.41(4)(d), Florida
Statutes (F.S.))
Commercial Fishing (as defined in s. 206.41(4)(c)3., F.S.)
The taxes paid on motor fuel used for sport and/or pleasure
Farmer (see s. 206.41(4)(c)2., F.S.) The taxes paid on
fishing do not qualify for a refund.
motor fuel placed in licensed and/or registered vehicles
do not qualify for a refund.
County (see s. 206.41(4)(d), F.S.)
Mass Transit System (as defined in s. 206.86(10), F.S.,
Private Schools (as defined in s. 1002.01(2), F.S., see
see 206.41(4)(b), F.S.) A contract defining the activity,
s. 206.41(4)(e), F.S.)
period, and expiration date must be included with the
Commercial Aviation Purposes (as defined in
DR-185.
s. 206.41(4)(c)4, F.S.)
Indicate Type(s) of Fuel Used:
Motor Fuel
Diesel Fuel
Alternative Fuel
Have you been convicted of bribery, theft, or false swearing within the last five years?
Yes
No
I hereby attest that all information provided hereon is true and correct.
Signature of Applicant or Authorized Agent
Title
Date
Mail application to:
1. Permits shall be effective for the calendar year issued by the Florida Department of Revenue, and
shall be continuous, so long as the permit holder files refund claims during the calendar year.
Florida Department of Revenue
2. Suppliers sales invoices are required to support the claim for refund.
Account Management Fuel Unit
3. No refund may be authorized unless a sworn or affirmed application is filed with the department
P.O. Box 6480
no later than the last day of the month following the quarter for which the refund is claimed.
Tallahassee, FL 32314-6480
4. Permits are not transferable, except to the executor or administrator of a deceased permit holder.
850
488-6800
5. The Florida Department of Revenue will require a corporate surety bond of $1,000 with an
)
(
Application For Refund Permit for any person who violates an applicable provision of Section
206.41, F.S., or is convicted of bribery, theft, or false swearing within the preceding five years, or if
NO FEE REQUIRED
the department has evidence of the applicant’s financial irresponsibility.
WITH THIS APPLICATION
For Official Use Only
Permit Number
Date Approved
Effective Date
Year End
Exam Initials
Social security numbers (SSNs) are used by the Florida Department of Revenue as unique identifiers for the administration of Florida’s taxes. SSNs
obtained for tax administration purposes are confidential under sections 213.053 and 119.071, Florida Statutes, and not subject to disclosure as
public records. Collection of your SSN is authorized under state and federal law. Visit our Internet site at and select
“Privacy Notice” for more information regarding the state and federal law governing the collection, use, or release of SSNs, including authorized
exceptions.
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