Form Tc-942 - Application For Undyed Diesel Fuel Tax Refund

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Utah State Tax Commission
SD-RF
94281
Application For Undyed
TC-942
Diesel Fuel Tax Refund
Rev. 12/08
(This form is for Utah based carriers only. Use form TC-922, if SFU account)
9998
Refund application may only be filed on a quarterly basis.
Name of entity requesting refund
FEIN or SSN
C
Mailing address (where refund is sent)
Check box if this is a SSN
SP
City, State, ZIP code
Filing period (mmddyyyy)
From:
To:
Part A: From Utah PTO Gallons Consumed (See Instructions)
1. Enter gallons disbursed into cement trucks
1
2. Cement truck exemption gallons (multiply line 1 by .20)
2
3. Enter gallons dispensed into trash compaction vehicles
3
4
4. Trash compaction vehicle exempt gallons (multiply line 3 by .20)
5
5. Enter the number of pounds of dry product loaded/off loaded in Utah
6. Divide line 5 by 6,000
6
7. Enter exemption allowance (see instructions)
7
8
8. Dry product loaded/off loaded PTO exempt gallons (multiply line 6 by line 7)
9. Enter the number of gallons of liquid product loaded/off loaded in Utah
9
10
10. Divide line 9 by 1,000
11. Enter exemption allowance (see instructions)
11
12
12. Enter liquid product loaded/off loaded PTO exempt gallons (multiply line 10 by line 11)
13
13. Other PTO gallons claimed (attach schedule of explanation if claiming an amount other than that allowed above)
14. TOTAL PTO gallons (add lines 2, 4, 8, 12 and 13)
14
Part B: Undyed Diesel Fuel Used For Qualifying Exempt Use in Motor Vehicle Engines in Utah
15
15. Enter total vehicle miles
16
16. Enter total gallons
17. Total gallons consumed by PTO units on vehicles, if applicable (from line 14)
17
18. Enter total gallons consumed for operation and propulsion of vehicles (subtract line 17 from line 16)
18
19. Miles per gallon (divide line 15 by line 18)
19
20. Miles traveled off-highway
20
21. Off-highway gallons (divide line 20 by line 19)
21
Part C: Undyed Diesel Fuel Used Other Than In Motor Vehicle Engines In Utah
Undyed diesel fuel purchased in Utah and dispensed into the secondary fuel tank of the vehicle
22
22.
when the fuel is used to operate a secondary device and is not used to propel the vehicle
23
Undyed diesel fuel purchased in Utah and dispensed into machinery/equipment not registered and
23.
not required to be registered for highway use.
24
24. Refundable non-highway gallons (add lines 22 and 23 and enter here)
Part D: Refund Calculation
25
25. Total refundable gallons (add lines 14, 21 and 24)
26
26. Refundable amount (multiply line 25 by the fuel tax rate)
27. Gallons exempt from sales and use tax - I certify the following gallons were consumed in -
a
b
Add box a and b
27
and enter total
a qualified manufacturing
Other: ________________
(explain) ______________
process
28. Gallons subject to sales and use tax (subtract line 27 from line 25)
28
29. Sales tax (see instructions) Enter average tax-free price ____________.
29
30. Net refund (subtract line 29 from the total from line 26)
30
I certify under penalties of perjury, this report is true, correct, and complete to the best of my knowledge.
Print name of person signing this form
Signature
Telephone number
Date signed

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