Form Au-474 - Application For Refund Of The Petroleum Business Tax Because Of A Bad Debt
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1AU-474
New York State Department of Taxation and Finance
Application for Refund of the
(9/11)
Petroleum Business Tax Because of a Bad Debt
Tax Law - Article 13-A, Section 301-I
Read instructions AU-474-I before completing this form.
Employer identification number (EIN)
Telephone number
(
)
For office use only
Legal name
Total approved
DBA
Audited by
Date
(if different than above)
Street address
Approved by
Date
City
State
ZIP code
Approved by
Date
1 Registration
Distributor of diesel motor fuel
Distributor of motor fuel
(mark an X in all that apply)
Residual petroleum product business
Retailer of non-highway diesel motor fuel
2 Federal tax return on which the bad debt was claimed:
Type of federal return (form number)
Period covered by the return:
from:
to:
Petroleum business tax (PBT) schedule of bad debts
A
B
C
D
E
F
G
Date of
Account name
Tax return
Type of
Unpaid amount
PBT rate
PBT included in
sale
period
product
(complete worksheet below
per gal.
unpaid amount
for partial payments)
Total PBT bad debt refund
(add column G amounts)
Worksheet for partial payments
(complete this worksheet if payments were made on the account)
Account name
Account name
Account name
(a) Selling price
....................
(not including finance charges)
(b) PBT included in the selling price .................................
(c) Percentage of PBT
..............................
(divide (b) by (a))
(d) Partial payment made on sale .....................................
(e) Amount of partial payment applied to PBT
(multiply (c) by (d))
(f) PBT allowed as bad debt refund
....
(subtract (e) from (b))
Transfer each row (f) amount to column G of PBT schedule of bad debts above.
Certification: I certify that all New York State Article 13-A taxes, for which this claim is filed, have been paid by me and this is
a true, correct and complete report.
Signature of authorized person
Official title
Authorized
person
E-mail address of authorized person
Date
Firm’s name
Firm’s EIN
Preparer’s PTIN or SSN
(or yours if self-employed)
Paid
preparer
Signature of individual preparing this return
Address
City
State
ZIP code
use
only
E-mail address of individual preparing this return
Preparer’s NYTPRIN
Date
(see instr.)
See instructions for where to file.
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