Form Ref-1000 - Claim For Fuel Tax Refund - Indiana Department Of Revenue
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5Form REF-1000
Indiana Department of Revenue
Mailing/Contact Information:
Indiana Department of Revenue
State Form 50854
Claim for Fuel Tax Refund
(R8 / 7-17)
Special Tax Division
P.O. Box 1971
Indianapolis, IN 46206-1971
(317) 615-2630
fetax@dor.in.gov
Section A: Information
Individual or Business Name
Social Security Number or Federal Identification Number
Street Address
Indiana Taxpayer Identification Number
City, State and ZIP Code
Refund Period
Telephone Number
Email Address
Use of Fuel (Only Check One):
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A – Agriculture
E – Local Transit Systems
I – Mining
M – Other (Specify)
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B – Aviation
F – Maintenance
J – Railroad
______________________________
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C – Building/Construction
G – Manufacturing
K – Refrigeration
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D – Export
H – Marine
L – Taxicabs
Section B: Refund Computation
Gasoline
Special Fuel
(Use Whole Gallons)
(Use Whole Gallons)
1. Gallons Used for Exempt Purposes (From Section C, Line 11)
2. Proportional Gallons Eligible for Fuel Tax Refund (From Section D,
Line 7)
3. Total Gallons Eligible for Fuel Tax Refund (Line 1 plus Line 2)
4. Fuel Tax Rate (See table below)
5. Fuel Tax Refund (Line 3 multiplied by Line 4)
6. Collection Allowance Adjustment
7. Total Fuel Tax Refund (Line 5 minus Line 6)
8. Tax Paid Gallons Used by Governmental Entities Eligible for Sur-
charge Tax Refund (From Section C, Line 12)
9. Proportional Gallons Eligible for Surcharge Tax Refund (From Sec-
tion D, Line 6) (Governmental Entities should not use this line)
10. Total Gallons Eligible for Surcharge Tax Refund (Line 1 plus Line 8
plus Line 9)
11. Surcharge Tax Rate (See table below)
12. Surcharge Tax Refund (Line 10 multiplied by Line 11)
13. Total Refund Claimed (Line 7 plus Line 12)
Fuel Tax Rate Table
Surcharge Tax Rate Table
Refund Tax Period
Gasoline Tax Rate
Special Fuel
Refund Tax Period
Surcharge Tax Rate
Tax Rate
Prior to July 1, 2017
Not Applicable
Prior to July 1, 2017
$0.18
$0.16
On or after July 1, 2017
$0.21
On or after July 1, 2017
$0.28
$0.26
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