Form Mf-004 - Instructions Retailer'S Claim For Gasoline Tax Refund printable pdf download

MF-004 INSTRUCTIONS

RETAILER’S CLAIM FOR GASOLINE TAX REFUND

gallons entered on line 1. Attach this documentation to the in-

Wisconsin law provides that any person who operates a retail

voices covered by that tape/spreadsheet.

service station may claim a refund of one-half of one percent

of the Wisconsin motor vehicle fuel tax paid on gasoline re-

DATES OF FUEL PURCHASES COVERED BY THIS CLAIM

ceived into that person’s retail storage facilities. This refund is

Enter the first and last gasoline purchase dates included in your

designed to compensate for shrinkage and evaporation losses.

refund claim.

Exceptions - Refunds may NOT be claimed on the following fuel

REFUND COMPUTATION SCHEDULE

purchases:

Line 2. Indicate the gallons included on line 1 which were not

1. Diesel fuel.

received into your retail storage.

2. Gasoline purchased by you and resold and shipped to

Line 3. The total must agree with the total gallons in the Retail

customers without being placed in your retail storage

Station Location Information at the bottom of the claim.

facilities.

3. Consignment purchases.

RETAIL STATION LOCATION INFORMATION

List the station name, address, and gallons of gasoline received

HOW TO OBTAIN A REFUND

at each of your retail stations included in this refund claim. Do

A refund may only be obtained by completing this claim form

not use post office box addresses.

and filing it with the Wisconsin Department of Revenue.

Sign and date the refund claim and include a contact telephone

DUE DATE

number.

You may file a refund claim for any of these periods: monthly,

quarterly, semi-annually, annually. A CLAIM MUST BE FILED

ASSISTANCE

WITHIN 12 MONTHS FROM THE DATE FUEL IS PURCHASED

You can access the department’s web site at

(not date of payment).

From this web site, you can:

• Complete electronic fill-in forms

DOCUMENTATION

• Download forms, schedules, instructions, and publications

Documentation of your gasoline purchases must accompany

• View answers to commonly asked questions

your claim in order to obtain a refund.

• E-mail for assistance

• Access My Tax Account

Select one of the two options below to detail your purchases.

Madison Office Location

1. Purchase Schedule (instead of invoices)

2135 Rimrock Road

You may submit a schedule listing your gasoline purchases

Madison WI 53713

instead of submitting invoices. A purchase schedule is pro-

vided on page 2 of this claim form. In lieu of completing

Mailing Address

this schedule, you may submit a computerized listing of your

Excise Tax Section 6-107

gasoline purchases. If you submit a computerized listing, it

Wisconsin Department of Revenue

MUST contain the same information on page 2. If your list-

PO Box 8900

ing includes all gasoline shipments, indicate with a red check

Madison WI 53708-8900

mark those shipments for which you are claiming a refund.

Phone: (608) 266-0064 or (608) 266-3223

2. Copies of Invoices

Fax: (608) 261-7049

E-mail: excise@revenue.wi.gov

Invoices must be submitted for your gasoline purchases.

You must submit a separate invoice for each purchase.

RECORDS

Grouping purchases on one invoice is not acceptable. Do

Keep a copy of this refund claim and all records used in pre-

not send original invoices as they will not be returned to you.

paring the claim for a minimum of four years. Keep these

More than one invoice may be photocopied to a single page

records in a place and manner that is easily accessible for

provided they were copied in ascending date order (oldest

invoice first) and all information is legible.

review by department representatives. The department re-

serves the right to review and adjust refund claims either be-

Each invoice prepared by your supplier must contain the

fore or after refund checks are issued.

following information.

1. Date of purchase

FRAUDULENT CLAIMS

2. Name and address of purchaser

Under sec. 78.73(1), Wis. Stats., any person who uses a

3. Name and address of seller

false or fictitious name when submitting a refund claim, or

4. Number of gallons purchased

commits any other fraud in preparing and submitting a claim,

5. Type of fuel purchased

may be fined not more than $500 or imprisoned not more than

6. Amount of Wisconsin fuel tax paid

6 months or both. Altering a purchase date on an invoice to

bring it within the 12 month time limitation for filing a refund

Your invoices must also be accompanied by documentation

claim is a fraudulent act.

(e.g., Excel spreadsheet, etc.) to show how you computed the

MF-004 Instr (R. 1-12)

Form Mf-004 - Instructions Retailer'S Claim For Gasoline Tax Refund

Related Articles

Related forms

Related Categories