Free Form AU-631 - New York

New York State Department of Taxation and Finance

Claim for Refund/Reimbursement of Taxes Paid on Fuel Used in a Vessel Engaged in Commercial Fishing
Tax Law -- Articles 12A, 13A, 28, and 29
Employer identification number (EIN) or social security number (SSN) Legal name DBA (doing business as) name (if different from legal name) Street address City, state, and ZIP code Name of vessel Business telephone number For tax period: ( ) Beginning

AU631
(9/06)
Ending

/
Total approved Audited by Approved by Approved by

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For office use only

/

/

Date Date Date

Computation of Refund/Reimbursement
1 Motor fuel excise tax paid ....................................... 2 Diesel motor fuel excise tax paid ............................ 3 Total Article 12A reimbursement requested (add lines 1 and 2, Column B) ................................. 4 Petroleum business tax paid (motor fuel) ............... 5 Petroleum business tax paid (diesel motor fuel)..... 6 Total Article 13A reimbursement requested (add lines 4 and 5, Column B) ................................. 7 State and local sales tax (motor fuel) ..................... 8 State and local sales tax (diesel motor fuel)........... 9 Total state and local sales tax refund requested (add lines 7 and 8, Column B) ................................. 10 Total refund/reimbursement requested (add lines 3, 6 and 9, Column C) ................................................ 1 2 3 4 5 6 7 8 9 10

Column A Gallons (from schedules)

Column B Tax paid (from schedules)

Column C Totals

Yes (complete the following) Third ­ Do you want to allow another person to discuss this claim with the Tax Dept? (see instructions) party Designee's name Designee's phone number Personal identification designee ( ) number (PIN)

No

Certification: I declare that to the best of my knowledge and belief this claim is just true, and correct. I understand that a willfully false representation is a misdemeanor under sections 1812, 1812(f), and 1817 of the New York State Tax Law and section 210.45 of the Penal Law, punishable by imprisonment for up to a year and a fine of up to $10,000 for an individual or $20,000 for a corporation. I understand that the Tax Department is authorized to investigate the validity of the exemption claimed or the accuracy of any information entered on this form.
Signature of authorized person Signature of individual preparing this claim Address City Official title Firm's name (or yours if self-employed) State ZIP code ID number Date Date

Paid preparer use only

Mail to: NYS TAX DEPARTMENT FUEL TAX REFUND UNIT PO BOX 5501 ALBANY NY 122050501

Page 2 of 4
Date of purchase

AU631 (9/06)
Seller's Name

Schedule A Motor Fuel Purchases
(Attach additional sheets if necessary.)
County Invoice number Number of gallons City Excise tax paid Petroleum business tax paid Sales tax paid

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

Schedule B Diesel Motor Fuel Purchases
(Attach additional sheets if necessary.)
County Invoice number Number of gallons Date of purchase Seller's Name City Excise tax paid

AU631 (9/06) Page 3 of 4
Petroleum business tax paid Sales tax paid

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

Page 4 of 4

AU631 (9/06)

Instructions
Who may use this form
Any person who is a commercial fisherman, defined as a person licensed by an appropriate federal or state agency for the purpose of engaging in the commercial harvesting of fish and who is engaged in the business of harvesting fish for sale, must use this form to claim a refund/reimbursement of the motor fuel or diesel motor fuel excise tax, the petroleum business tax, and the state and local sales tax on the fuel purchased for use in the operation of a commercial fishing vessel engaged in the harvesting of fish for sale. You are not authorizing the designee to receive your refund check, bind you to anything (including any additional tax liability), or otherwise represent you before the Tax Department. If you want the designee to perform those services for you, you must file Form POA1, Power of Attorney, making that designation with the Tax Department. Copies of statutory tax notices or documents (such as a Notice of Deficiency) will only be sent to your designee if you file Form POA1. You cannot revoke the thirdparty designee authorization or change the PIN. However, the authorization will automatically end on the due date (without regard to extensions) for filing your claim.

When to File
A claim for refund/reimbursement should be filed for a full monthly period; however, a claimant may include more than one month in a single claim. Each monthly period should begin on the first and end on the last day of a calendar month. Claims for 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 should be filed within three years from the date the tax was due.

Line instructions
Lines 1 and 2 -- Enter the number of gallons and applicable excise tax paid from Schedule A and Schedule B. Lines 4 and 5 -- Enter the number of gallons and applicable petroleum business tax paid from Schedule A and Schedule B. Lines 7 and 8 -- Enter the number of gallons and applicable state and local sales tax paid from Schedule A and Schedule B.

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 claim form, including schedules A and B. Attach a worksheet, if necessary, and include adding machine tapes if the worksheet is not computergenerated. · You must furnish legible copies of purchase invoices showing each tax (motor fuel and/or diesel motor fuel excise tax, petroleum business tax, and sales tax) listed separately. · You must include a copy of your current United States Coast Guard documentation, if your vessel is required to be documented, and with the first claim each calendar year include a copy of your current Federal Fisheries Permit and/or your current license issued by the New York State Department of Environmental Conservation. · You must include the telephone number for your business in case we need to contact you concerning your refund/reimbursement. Additional documentation may be requested by the Tax Department upon review of the refund/reimbursement claim submitted. Thirdparty designee If you want to authorize another person (thirdparty designee) to discuss your claim with the New York State Tax Department, mark an X in the Yes box in the Third-party designee area of your claim. Also, enter the designee's name, phone number, and any fivedigit number the designee chooses as his or her personal identification number (PIN). If you want to authorize the paid preparer who signed your claim to discuss it with the Tax Department, enter Preparer in the space for the designee's name. You do not have to provide the other information requested. If you mark the Yes box, you are authorizing the Tax Department to discuss with the designee any questions that may arise during the processing of your claim. You are also authorizing the designee to: · give the Tax Department any information that is missing from your claim; · call the Tax Department for information about the processing of your claim or the status of your refund; and · respond to certain Tax Department notices that you shared with the designee about math errors, offsets, and claim preparation. The notices will not be sent to the designee.

Schedules A and B
Complete all columns of Schedules A and B. Enter information for those purchases for which a refund/reimbursement is claimed. Attach copies of all invoices listed. Attach additional sheets if necessary. Be sure to total the Number of gallons, Excise tax paid, Petroleum business tax paid and Sales tax paid columns. The totals of these columns must be carried to the front page as indicated.

Need help?
Internet access: www.nystax.gov (for information, forms, and publications) Faxondemand forms: 1 800 7483676

Telephone assistance is available from 8:00 A.M. to 5:00 P.M. (eastern time), Monday through Friday. To order forms and publications: 1 800 4628100 Business Tax Information Center: 1 800 9721233 From areas outside the U.S. and outside Canada: (518) 4856800 Hearing and speech impaired (telecommunications device for the deaf (TDD) callers only): 1 800 6342110 Persons with disabilities: In compliance with the Americans with Disabilities Act, we will ensure that our lobbies, offices, meeting rooms, and other facilities are accessible to persons with disabilities. If you have questions about special accommodations for persons with disabilities, please call 1 800 9721233.
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 5a, 171, 171a, 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 2255829. From areas outside the United States and outside Canada, call (518) 4856800.