Form Sft-9 - Special Fuels Refund Application
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1
2Rev. 10/03
Form SFT-9
Massachusetts
Special Fuels Refund Application
Department of
Special Fuels Excise, MGL Ch. 64E
Revenue
Claim must be filed within two years of the date of purchase. Attach original sales receipts. Application must be filled out in its entirety. Mail
to Massachusetts Department of Revenue, PO Box 7012, Boston, MA 02204.
Name of applicant
Federal ID or Social Security number
Telephone
Address
City/Town
State
Zip
From whom were special fuels purchased?
Date of first purchase
Date of last purchase
Do you have storage facilities for special fuels?
Storage capacity (in gallons)
Yes
No
Type of business
Non-taxable purpose for which special fuels were used
Do you apply for any other motor fuel refunds?
Do you owe any Massachusetts state taxes?
Yes
No. If “Yes,” list type(s):
Yes
No
Number of motor vehicles and pieces of equipment owned or operated,
Registered
Unregistered
including automobiles, trucks, graders, loaders and tractors
Note: All International Fuel Tax Agreement (IFTA) motor carrier licensees are required to remit copies of their quarterly IFTA reports
for the periods listed below with this application.
Tax Refund Computation.
First in/first out basis must be used. Fuel should be entered as whole gallons.
a. Jan.–Mar.
b. Apr.– June
c. Jul.–Sep.
d. Oct.–Dec.
11 Gallons of special fuels on hand at beginning of each period . . . . . . . . . . . . 1
12 Special fuels purchased each period . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
13 Add lines 1 and 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
14 Special fuels on hand at close of business of each period. . . . . . . . . . . . . . . 4
15 Subtract line 4 from line 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
16 Special fuels used for propulsion of vehicles registered for highway use . . . 6
17 Special fuels sold . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
18 Special fuels unaccounted for . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
19 Special fuels used on which a refund is claimed . . . . . . . . . . . . . . . . . . . . . . 9
10 Tax rate per gallon . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
$
.21
$
.21
$
.21
$
.21
11 Amount of excise refund. Multiply line 9 by line 10 . . . . . . . . . . . . . . . . . . . . 11
$
$
$
$
Adjustment for use tax
12 Cost of special fuels reported in line 9 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
$
$
$
$
13 Enter amounts from line 11 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
14 Amount subject to use tax. Subtract line 13 from line 12 . . . . . . . . . . . . . . . 14
15 Use tax. Multiply line 14 by .05 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
16 Amount to be refunded each period. Subtract line 15 from line 11 . . . . . . . 16
$
$
$
$
17 Total amount to be refunded. Add line 16, columns a, b, c and d . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
$
Supplier’s name, address, date of purchase and number of gallons purchased must be on each sales receipt. Sales receipts will be
returned if a written request accompanies the application. Application subject to audit. Complete records must be kept three years for
verification by a representative of the Commissioner. If there is any evidence of erasures or changes in either dates or amounts shown
on sales receipts, application will be disallowed in its entirety. Answer all questions on reverse or application will be disallowed.
Claims based on estimates are not acceptable.
The undersigned applicant states under the penalties of perjury that all information contained in this application is true,
correct and complete and that the undersigned has complied with all laws of the Commonwealth relating to taxes.
Signature of applicant or person authorized to sign
Date
printed on recycled paper
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