Form Mfr-44 - Application For Refund Non-Highway Clear Diesel/gasoline

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Mailing Address:
Form MFR-44 (Rev. 2/13)
Motor Fuel Tax Unit
Application for Refund
Georgia Department of Revenue
Non-Highway Clear Diesel/Gasoline
PO Box 105088
Atlanta, GA 30348-5088
Tax Law Information: This form covers Subsection (I) of Section 92-1403 of the Motor Fuel Tax Law (January 26,
1946); and Title 48, Chapter 9-10 (a)(3) Article 1 – The Motor Fuel Tax Law.
1. FEIN
2. SSN
3. PERMIT NUMBER (IF APPLICABLE)
5. PERIOD END
4. PERIOD START
APPLICANT INFORMATION
6. NAME
7. DBA
8. LOCATION ADDRESS
CITY
STATE
ZIP CODE
CITY
STATE
ZIP CODE
9. MAILING ADDRESS
10. TELEPHONE NUMBER
11. EMAIL ADDRESS
Banking Information
Direct Deposit (Check ONLY if you would like your refund to be directly deposited into your bank account)
Account Type:
Checking
Savings
Routing Number:
Account Number:
PART 1
Specify the type of fuel that you are claiming refund for by checking one of the checkboxes below.
Gasoline Used for Agricult ure Equipment (Use Schedule B)
Clear Diesel (Use Schedule A)

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