Free TC-114S, Application for Government Special Fuel Tax Refund - Utah


File Size: 60.0 kB
Pages: 2
Date: January 12, 2009
File Format: PDF
State: Utah
Category: Tax Forms
Word Count: 515 Words, 3,120 Characters
Page Size: Letter (8 1/2" x 11")
URL

http://tax.utah.gov/forms/current/tc-114s.pdf

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Utah State Tax Commission

SG-RF
TC-114S
Rev. 12/08

Application For Government Special Fuel Tax Refund

Telephone: 801-297-2200 for assistance (1-800-662-4335 outside Salt Lake City but inside Utah)
Name Federal Identification Number

Mailing address City, State, ZIP code

Filing period (Begin: mmyy End: mmyy) Begin: End:

Refund application may not be filed more often than quarterly.
Invoice number Transaction date Vendor's name and address Number of gallons Number of of undyed diesel gallons of fuel purchased CNG purchased Special fuel tax paid

TOTALS

$

I certify that I meet all the conditions to qualify for this refund. I have examined this refund application, including any accompanying schedules, and certify that to the best of my knowledge it is true, correct and complete.
Print name of person signing this form Signed X Date signed Title Telephone number

If you need an accommodation under the Americans with Disabilities Act, contact the Tax Commission at 801-297-3811 (TDD 801-297-2020). Please allow three working days for a response.

General Information
Utah Code Section 59-13-301 allows federal and Utah state and local government entities to file for a refund of Utah special fuel taxes paid on CNG and undyed diesel purchased for government use. For purposes of this law, diesel fuel is defined as any liquid commonly used as a fuel in a diesel engine. This refund applies only to diesel and CNG fuel purchased for the government's official and exclusive use in government vehicles, aircraft, and equipment. Sale or delivery to individuals or to other businesses operating under government contract, personal use, for retail sale on or off government property or any other distribution to third parties does not qualify for this refund. Government entities that are members of (participate in) the State Fuel Network (Network) and use gascards through Fleet Services may not request a fuel tax refund directly from the Tax Commission. Fleet Services will handle all fuel tax refunds for members of the Network, including purchases made outside of the Network. Refund claims for special fuel taxes paid on undyed diesel or CNG may be filed within 30 days after the end of any calendar quarter, for taxes accumulated for that calendar quarter. If you need additional help or information, contact the Utah State Tax Commission at 801-297-2200 or, if outside the Salt Lake area but within Utah, call 1-800-662-4335. Original records supporting the refund claim must be maintained by the government entity for three years following the year of refund. File this refund claim with the Utah State Tax Commission, 210 North 1950 West, Salt Lake City, Utah 84134.

Instructions For Completing This Form
Enter the full name, address, and Federal Identification Number of the government entity applying for the refund in the space provided. Use this same name and number whenever you file for a refund. You must provide all information requested on this form for each purchase of CNG or undyed diesel fuel for which you paid Utah special fuel taxes. Attach additional forms if necessary.