Form Tc-116 - Utah Application For Fuel Tax Refund
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3Utah State Tax Commission
11601
TC-116
Utah Application for
Rev. 9/10
Fuel Tax Refund
9998
FEIN/SSN
Name
Mark “X” if this is
a new address:
Address
_____ Physical
_____
Mark "X" if this is a SSN
address
City
State
ZIP code
Tax period (mmddyyyy)
_____ Mailing
From
To
address
Foreign country (if not U.S.)
Telephone number
A - Motor fuel
B - Undyed diesel
C - Aviation fuel
D - CNG
Utah Excise Tax
1. Utah tax-paid gallons purchased by government
entities (from Schedule type 1A)
2. Utah tax-paid gallons exported from Utah
(from Schedule type 1B)
3. Utah tax-paid gallons purchased by Ute Indian Tribe
(from Schedule type 1C)
4. Utah tax-paid gallons purchased by non-profit
agricultural entities (from Schedule type 1D)
5. Total eligible gallons of fuel lost or destroyed by
fire, flood, crime & accident (from Schedule type 1E)
6. Total eligible gallons for each single transaction of 4,500 or
more discharged in bankruptcy (from Schedule type 1F)
7. Gallons returned to refinery for re-refining
00
(from Schedule type 1G)
8. Total tax-paid gallons (add lines 1 through 7)
9. Total tax-paid gallons of aviation fuel at 2.5 cents
(from Schedule1H)
10. Tax per gallons of aviation fuel at 2.5 cents
00
(multiply line 9 column C by .025)
11. Total tax-paid gallons of aviation fuel at 4 cents
(from Shedule 1I)
12. Tax per gallons of aviation fuel at 4 cents
00
(multiply line 11 column C by .04)
13. Total tax-paid gallons of aviation fuel at 9 cents
(from Schedule 1J)
14.
Tax per gallons of aviation fuel at 9 cents
00
00
00
00
(multiply line 13 column C by .09)
.245
.245
.085
00
15. Tax rates
16. Calculated tax-paid (multiply line 8 by line 15 from columns
00
00
00
00
A, B, and D; and add lines 10, 12, and 14 for column C)
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Parent category: Financial