Form Au-631 - Claim For Refund/reimbursement Of Taxes Paid On Fuel Used In A Vessel Engaged In Commercial Fishing
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4AU‑631
New York State Department of Taxation and Finance
Claim for Refund/Reimbursement of Taxes Paid on Fuel
(4/11)
Used in a Vessel Engaged in Commercial Fishing
Tax Law — Articles 12‑A, 13‑A, 28, and 29
For tax period:
Employer identification number (EIN) or social security number (SSN)
Business telephone number
(
)
Beginning
Ending
/
/
/
/
Legal name
For office use only
DBA (doing business as) name
(if different from legal name)
Total approved
Street address
Audited by
Date
City, state, and ZIP code
Approved by
Date
Name of vessel
Approved by
Date
Column A
Column B
Column C
Computation of Refund/Reimbursement
Gallons
Tax paid
Totals
(from schedules)
(from schedules)
1 Motor fuel excise tax paid ......................................
1
2 Diesel motor fuel excise tax paid ...........................
2
3 Total Article 12‑A reimbursement requested
.................................
3
(add lines 1 and 2, Column B)
4 Petroleum business tax paid (motor fuel) ...............
4
5 Petroleum business tax paid (diesel motor fuel) ....
5
6 Total Article 13‑A reimbursement requested
.................................
6
(add lines 4 and 5, Column B)
7 State and local sales tax (motor fuel) .....................
7
8 State and local sales tax (diesel motor fuel)...........
8
9 Total state and local sales tax refund requested
.................................
9
(add lines 7 and 8, Column B)
10 Total refund/reimbursement requested
(add lines 3,
................................................
10
6 and 9, Column C)
Third –
Do you want to allow another person to discuss this claim with the Tax Dept?
Yes
No
(see instructions)
(complete the following)
party
Designee’s name
Designee’s phone number
Personal identification
designee
(
)
number (PIN)
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
Official title
Date
Mark
Preparer’s signature
Date
Preparer’s NYTPRIN
Preparer’s SSN or PTIN
Paid
an X if
preparer
self-employed
use
Preparer’s firm name
Firm’s EIN
E-mail
(or yours, if self-employed)
only
Address
Telephone number
(
)
Mail to: NYS TAX DEPARTMENT, FUEL TAX REFUND UNIT, PO BOX 5501, ALBANY NY 12205‑0501
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