Iowa Motor Fuel / Special Fuel Tax Refund Worksheet
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2Iowa Motor Fuel / Special Fuel Tax Refund Worksheet
Iowa Department of Revenue
82-052a (06/22/11)
This worksheet is intended to assist you in filing for motor fuel or special fuel tax refunds by telephone. This worksheet pertains to the computational
part of the claim – items 8 through 18 of the call card. It is recommended that you make extra copies of a blank worksheet and have a completed copy on
hand each time you file a claim by telephone. You should also refer to form 90-214 (Call Card Glossary and Supplementary Instructions) and explanations
on the reverse side while completing the worksheet. After completing the worksheet you may file your claim by dialing 1-800-200-2293.
*A separate worksheet is required when periods before and after July 1 are included.
Earliest Invoice
Last Invoice
Refund Permit: __________________
Period covered by this claim (mm/dd/yy): from __________ to __________
1. A 2-digit number from the box at upper
1. ___________
1. ___________
1. ____________
Claim Type Number
Commercial
claim type no.
claim type no.
claim type no.
right. ITEM 8 on call card
61 • Reefer
21 • Agricultural Production
2. A 3-digit number from the box at lower
2. ___________
2. ___________
2. ____________
62 • Pumping Dry Product
fuel type no.
fuel type no.
fuel type no.
31 • Federal Government
right. ITEM 9 on call card
63 • Pumping Wet Product
32 • State Government
3. Base Quantity in gallons or tons,
3. ___________
3. ___________
3. ____________
64 • Idling
33 • Other Political Subdivision
whole numbers
whole numbers
whole numbers
whichever is applicable. ITEM 10 on call
65 • Power Takeoff
card
34 • Urban Transit System
66 • Off Road
%
%
%
35 • Regional Transit System
4. Percentage – See explanation on
4. ___________
4. ___________
4. ____________
67 • Export of Tax Paid Fuel
36 • Native American
reverse side. ITEM 11 on call card
68 • Ready Mix
41 • Contract Carrier
5. Total Gallons Claimed for Refund:
5. ___________
5. ___________
5. ____________
69 • Solid Waste
whole numbers
whole numbers
whole numbers
51 • Commercial Fisher
Multiply Base Quantity (line 3) by
Refund Agent
Percentage (line 4).
52 • Home Heating
71 • Reefer
53 • Extract/Process Natural
6. Tax rate for fuel type from box at lower
6. ___________
6. ___________
6. ____________
72 • Pumping Dry Product
right.
Deposits
.
.
.
73 • Pumping Wet Product
54 • Denaturing Alcohol
7. Tax Paid on Gallons Claimed: Line 5
7. ___________
7. ___________
7. ____________
74 • Idling
multiplied by line 6.
.
.
.
75 • Power Takeoff
8. Net Cost of Fuel: Line 5 multiplied by
8. ___________
8. ___________
8. ____________
(average cost per gallon of the fuel less
Fuel Type (Tax per Gallon)
the Iowa fuel tax included in the average
054 • LPG (20¢)
123 • Alcohol (19¢)
cost). ITEM 15 on call card
.
.
.
065 • Gasoline
124 • Gasohol (19¢)
9. Iowa Sales Tax: See explanation on
9. ___________
9. ___________
9. ____________
125 • Aviation Gas (8¢)
7-1-07 through 6-30-08 (20.7¢)
reverse side.
.
.
.
On or after 7-1-08 (21.0¢)
130 • Jet Fuel (3¢)
10. Net Refund per Fuel/Claim Type:
10. ___________
10. ___________
10. ____________
079 • E85
169 • Undyed Diesel/Bio-Fuel/
Subtract line 9 from line 7. ITEM 16 on
Kerosene (22.5¢)
on or after 7-1-07 (19¢)
call card
11. Total Refund Claimed: Add entries on
TOTAL REFUND CLAIMED 11. ____________
line 10 for all columns and enter total.
ITEM 18 on call card
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