Free TC-126 - Utah

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Utah State Tax Commission

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TC-126 Rev. 8/02

Application for Navajo Nation Fuel Tax Refund

Name Street address City, State, Zip code

Federal ID number Filing period (Begin: mmyy End: mmyy) Begin: _______ End: _______

General Information You must first complete the Navajo Tax Commission Monthly Fuel Distributor Tax Return, form 900, to prepare this refund application. You must attach a completed copy of Navajo form 900, including all schedules and fuel manifests, to this refund application. A refund application may be filed on a monthly basis and should be filed on or before the 30th day following the refund period. You must retain original records supporting this refund application for three years following the year of the refund. Mail or bring the refund application, with all required attachments to the Utah State Tax Commission, 210 North 1950 West, Salt Lake City, Utah 84134-0511. For assistance: Web Site: www.tax.utah.gov Phone: 801-297-2200 Toll Free: 800-662-4335

1. Total Navajo Nation taxable gallons (from line 3, form 900, Navajo Distributor Tax Return)

2. Gallons delivered to non-Utah portion of Navajo Nation (if included on line 3, form 900, Navajo Distributor Tax Return)

3. Total gallons delivered to Utah portion of Navajo Nation (subtract line 2 from line 1)

4. Dyed diesel fuel gallons included on line 3

5. Total gallons subject to Utah fuel tax (subtract line 4 from line 3)

6. Navajo 0.5% credit, if taken on line 4, form 900, Navajo Distributor Tax Return (multiply line 5 by .005)

7. NET taxable gallons available for Utah fuel tax refund (subtract line 6 from line 5)

8. REFUND (multiply line 7 by .18)

$

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.
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If you need an accommodation under the Americans with Disabilities Act, contact the Tax Commission at (801) 297-3811 IMPORTANT: To protect your privacy, use the "Clear form" button when you are finished. Clear form (TDD (801) 297-3819). Please allow three working days for a response.