Form Ref-1000 - Consolidated Application For Fuel Tax Refund Page 2
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6Before a refund can be authorized, all applicable areas must be completed.
Section III: Gasoline and/or Special Fuel-Consuming Equipment (Section IV or V Must Also Be Completed)
List all fuel-consuming equipment, including licensed vehicles, non-highway equipment, and building construction equipment. Indicate the
total gallons of fuel consumed by vehicle and/or equipment type during the period for which the refund is claimed.
Amount of gasoline and/or special fuel used
Type
Make
License Number
Model
Gasoline
Special Fuel
Gal
Gal
Gal
Gal
Gal
Gal
Gal
Gal
Gal
Gal
Gal
Gal
Gal
Gal
(Attach additional list if necessary.)
Carry to Section II
Carry to Section II
Line 5A
Line 5B
Total Gallons
Section IV: Gasoline and/or Special Fuel Used in Agricultural Production (Listed in Section III Above)
Number of acres owned or rented for use by applicant ____________________ Acres under cultivation _____________________
Acres custom-farmed that are not owned or rented by the applicant ________________________________
Indicate the type of crops farmed, the
Total Operations*
acreage per crop, and the total number of
for Each Crop
operations* performed for each crop listed
Crop
Crop Acreage
Gasoline
Special Fuel
(attach additional list if necessary).
*Operations may include each time you
plow, disk, plant, cultivate, etc.
List the number of gallons of gasoline or special fuel consumed in other farm operations, such as fuel used in the care of live-
stock, to grind feed, to pump water, etc.
Gasoline
Special Fuel
Describe these uses in detail. Be sure to indicate the number and type of livestock.
Gal
Gal
Section V: Motorboats and Other Exempt Uses (Listed in Section III Above)
If the tax paid gasoline and/or special fuel is used in a motorboat, indicate the river or lake on which the motorboat was operated.
________________________________________________________________________________________________________
Other Exempt Uses (provide detailed explanation)
________________________________________________________________________________________________________
________________________________________________________________________________________________________
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