Free Form AU-629 - New York


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State: New York
Category: Tax Forms
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URL

http://www.tax.state.ny.us/pdf/2006/motor/au629_906.pdf

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New York State Department of Taxation and Finance

Application for Refund/Reimbursement of Taxes Paid on Fuel Sold to Governmental Entities by Registered Distributors
Tax Law -- Articles 12-A, 13-A, 28, and 29
Employer identification or social security number Legal name Business telephone number

AU-629
(9/06)

(

)

For tax period:
Beginning Ending

For office use only
DBA (if different from legal name) Street address City, state, and ZIP code Total approved Audited by Approved by Date Date

Computation of reimbursement
1 Motor fuel excise tax paid ................................ 2 Diesel motor fuel excise tax paid ..................... 3 Total Article 12-A refund requested
(add lines 1 and 2, Column B; enter here and on Form PT-100-B for the same calendar month) ......

Gallons (from schedules) 1. 2.

Column A

Tax paid (from schedules)

Column B

Column C
Totals

3. 4. 5.

4 Petroleum business tax (motor fuel) .................. 5 Petroleum business tax (diesel motor fuel)......... 6 Total Article 13-A refund/reimbursement requested (add lines 4 and 5, Column B; enter
here and on Form PT-100-B for the same calendar month) .................................................

6. 7. 8.

7 Prepaid sales tax (motor fuel) ........................... 8 Prepaid sales tax (diesel motor fuel) .................. 9 Total prepaid sales tax refund requested
(add lines 7 and 8, Column B; enter here and on Form FT-945/1045 for the same calendar month and deduct from the credit claimed) ......................

9.

10 Total refund requested (add lines 3, 6 and 9,
Column C) ................................................... 10.

Certification: I certify that this is a true, correct, and complete report.
Signature Preparer's signature Firm's name (or yours, if self-employed) Address ZIP code Power of attorney attached? Date Title EIN or social security number Date Telephone number

Paid preparer's use only

(

)

Yes

No

Mail to: NYS TAX DEPARTMENT, FUEL TAX REFUND UNIT, PO BOX 5501, ALBANY NY 12205-5501

Page 2 of 4

AU-629 (9/06)

Schedule A - Motor fuel sales to governmental entities (Attach additional sheets if necessary)
Purchaser's Date of sale Name City County Invoice number Number of gallons sold exempt Taxes prepaid by seller Petroleum Excise tax Sales tax business tax

11 Total gallons purchased (enter here and on lines 1, 4 and 7, Column A) ......... 12 Total excise tax paid/refund claimed (enter here and on line 1, Column B)............................ 13 Total petroleum business tax paid/refund claimed (enter here and on line 4, Column B) ............................ 14 Total prepaid sales tax paid/refund claimed (enter here and on line 7, Column B) .....................................................................

AU-629 (9/06) Page 3 of 4

Schedule B - Diesel motor fuel sales to governmental entities (Attach additional sheets if necessary)
Purchaser's Date of sale Name City County Invoice number Number of gallons sold exempt Taxes prepaid by seller Petroleum Excise tax business tax Sales tax

15 Total gallons purchased (enter here and on lines 2, 5 and 8, Column A) ....... 16 Total excise tax paid/refund claimed (enter here and on line 2, Column B)........................... 17 Total petroleum business tax paid/refund claimed (enter here and on line 5, Column B) ............................ 18 Total prepaid sales tax paid/refund claimed (enter here and on line 8, Column B) .....................................................................

Page 4 of 4

AU-629 (9/06)

Instructions
Line instructions
Lines 1 and 2 - Enter the number of gallons and applicable excise tax paid from Schedule A and Schedule B. Line 3 - Add the tax paid on lines 1 and 2, (Column B) and enter on this line. Lines 4 and 5 - Enter the number of gallons and applicable petroleum business tax paid from Schedule A and Schedule B. Line 6 - Add the tax paid on lines 4 and 5, (Column B), and enter on this line. Lines 7 and 8 - Enter the number of gallons and applicable prepaid sales tax paid from Schedule A and Schedule B. Line 9 - Add the tax paid on lines 7 and 8, (Column B) and enter on this line. Line 10 - Add lines 3, 6 and 9 and enter the total on this line.

Who may use this form
Any person who is registered with the Department as a Diesel Motor Fuel Distributor and/or a Motor Fuel Distributor, may use this form to claim a refund/reimbursement of the taxes prepaid to their supplier on fuel sold to governmental entities. The refund/ reimbursement claimed on this form can only be for the taxes for which you hold a valid license issued by the Department. For example, if you are licensed as a Diesel Motor Fuel Distributor and you are also a wholesaler/retailer of motor fuel and are not licensed with the Department as a Motor Fuel Distributor, you may use this form to claim your refund/reimbursement for the taxes prepaid on the diesel motor fuel sold to governmental entities, but you must use Form FT-946 to claim your refund for the taxes paid on motor fuel sold to governmental entities.

When to file
An application for refund/reimbursement may be filed on a weekly basis. For distributors filing refund/reimbursement applications for periods of less than one month, the period covered by the application must begin and end in the same calendar month. Claims for refund/reimbursement of the motor fuel or diesel motor fuel excise tax and the petroleum business tax must be filed within three years from the date of purchase. Claims for refund of the New York State and local sales tax must be filed within three years from the date the tax was due.

Schedules A and B
Complete all columns of Schedules A and B. Enter information for those sales for which a refund/reimbursement is claimed. Include your sales of motor fuel on Form PT-101.3, Nontaxable Sales of Motor Fuel, or PT-102.2, Diesel Motor Fuel Nontaxable Sales, for the month of sale. Attach copies of all invoices listed. Attach additional sheets if necessary. Be sure to total the Number of gallons sold exempt and Taxes prepaid by seller columns. The totals of these columns must be carried forward to page 1 as indicated. Mail to: NYS TAX DEPARTMENT
FUEL TAX REFUND UNIT PO BOX 5501 ALBANY NY 12205-0501

General instructions
In order to expedite the processing of a refund/reimbursement claim, a claimant must furnish the necessary substantiation and adhere to the following procedures: -- You must complete the entire application and schedules. Attach a worksheet, if necessary, and include adding machine tapes if the worksheet is not computer generated; -- You must furnish proof of tax-paid purchases in the form of purchase invoices showing each tax (motor fuel and/or diesel motor fuel excise tax, petroleum business tax and prepaid sales tax) listed separately; -- You must furnish proof of tax-free sales in the form of sales invoices issued to the governmental entity; -- Include the telephone number for your business in case we need to contact you concerning your refund/reimbursement. If you prefer that we communicate with your representative (accountant, attorney, etc.), you must include a properly executed power of attorney. Additional documentation may be requested by the Tax Department upon review of the refund/reimbursement application submitted. After the refund/reimbursement has been paid, the purchase and sales invoices will be returned provided a stamped self-addressed envelope with sufficient postage is sent with this application. You must keep all records and other supporting documents, including those related to purchases and use, used to complete this refund/reimbursement application for a period of at least three years and be able to produce them upon request of the Tax Department.

Privacy notification The Commissioner of Taxation and Finance may collect and maintain personal information pursuant to the New York State Tax Law, including but not limited to, sections 5-a, 171, 171-a, 287, 308, 429, 475, 505, 697, 1096, 1142, and 1415 of that Law; and may require disclosure of social security numbers pursuant to 42 USC 405(c)(2)(C)(i). This information will be used to determine and administer tax liabilities and, when authorized by law, for certain tax offset and exchange of tax information programs as well as for any other lawful purpose. Information concerning quarterly wages paid to employees is provided to certain state agencies for purposes of fraud prevention, support enforcement, evaluation of the effectiveness of certain employment and training programs and other purposes authorized by law. Failure to provide the required information may subject you to civil or criminal penalties, or both, under the Tax Law. This information is maintained by the Director of Records Management and Data Entry, NYS Tax Department, W A Harriman Campus, Albany NY 12227; telephone 1 800 225-5829. From areas outside the United States and outside Canada, call (518) 485-6800.