Form Dr-309640 - Application For Refund Of Tax Paid On Undyed Diesel Consumed By Motor Coaches During Idle Time In Florida - 2014
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5Florida Department of Revenue
DR-309640
R. 01/13
Application for Refund of Tax Paid on Undyed Diesel
Rule 12B-5.150
Consumed by Motor Coaches During Idle Time in Florida
Florida Administrative Code
Effective 01/13
2014
THIS APPLICATION IS TO BE USED FOR CALENDAR YEAR
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NOTE: Your refund application will be rejected if fields in red are not completed in full.
Name of applicant:
. . . . .
Business street address:
.
Business city, state, ZIP:
.
Mailing street address:
. .
Mailing city, state, ZIP:
. .
Contact person:
. . . . . . .
Applicant federal employer
Telephone number
–
identification number:
(include area code):
Applicant Florida sales tax
Email address:
number (if applicable)
Business Partner Number:
Part I – Computation of Net Refund Due
1.
Total gallons of undyed diesel fuel consumed by motor coach during idle in Florida
(from Part III - Idle Consumption Schedule - “Total Gallons Eligible for Refund”) ......................................
______________________________________
2.
Total gallons of undyed diesel fuel purchased in Florida (Part IV, Line 1) ...................................................
______________________________________
3.
Net refundable gallons (lesser of Line 1 or Line 2) ......................................................................................
______________________________________
0.313
4.
Amount refundable per gallon ....................................................................................................................
______________________________________
5.
Total fuel tax refund (Line 3 multiplied by Line 4) ........................................................................................
______________________________________
$
6.
Average cost per gallon excluding fuel tax (Part II, Line 17) .....................................................................
______________________________________
$
7.
Net cost of refundable gallons (Lines 3 multiplied by Line 6) ...................................................................
______________________________________
$
8.
Total state sales tax (Line 7 multiplied by 6%) ..........................................................................................
______________________________________
$
9.
Total discretionary sales surtax (Line 7 multiplied by discretionary sales surtax rate) .............................
______________________________________
$
10. Total sales tax due (Line 8 plus Line 9) .....................................................................................................
______________________________________
$
,
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11. Net refund due (Line 5 minus Line 10) ......................................................................................................
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Part II – Computation of Average Cost Per Gallon
12. Total gallons of undyed diesel fuel purchased in Florida (Part IV, Line 1) .................................................
_______________________________________
$
13. Total cost of fuel purchased in Florida (Part IV, Line 2) .............................................................................
_______________________________________
0.313
14. Total state & local option fuel tax rate for undyed diesel ..........................................................................
_______________________________________
$
15. Total state & local option fuel tax paid on purchases (Line 12 multiplied Line 14) ...................................
_______________________________________
$
16. Cost of fuel (Line 13 minus Line 15) ..........................................................................................................
_______________________________________
17. Average cost per gallon (Line 16 divided by Line 12 - carry to 4 decimal places)
$
Enter here and on Part I, Line 6 ................................................................................................................
_______________________________________
Under penalty of perjury, I decalre that I have read this application and the facts stated in it are true.
______________________________________________________
_____________________________________________________
Signature of Applicant
Date
Mail to : Florida Department of Revenue, Refunds, PO Box 6490, Tallahassee FL 32314-6490
Fax 850-410-2526
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