Form B/l: Mft-Pre - Exempt Entity Petition For Refund
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1
2B&L: MFT-PRE
A
D
R
LABAMA
EPARTMENT OF
EVENUE
6/12
B
& L
T
D
USINESS
ICENSE
AX
IVISION
RESET
M
F
S
OTOR
UELS
ECTION
P.O. Box 327540 • Montgomery, AL 36132-7540 • (334) 242-9608 • Fax (334) 242-1199
Exempt Entity Petition for Refund
For Motor Fuel Purchases by Exempt Entities as Listed in Section 40-17-329(e)
NAME
QUARTER ENDING
ADDRESS
FEIN
CITY
STATE
ZIP
CONTACT PERSON
TELEPHONE NUMBER
(
)
E-MAIL ADDRESS
Check here if new address
TYPE OF ENTITY (CHECK ONE):
United States Government Agency
Alabama Institute for Deaf and Blind
County Governing Body
Department of Youth Services School District
Incorporated Municipal Governing Body
Private and Church School Systems (K-12)
City and County Boards of Education
TAX REFUND CALCULATION:
Gasoline
Undyed Diesel
Aviation Gas
Jet Fuel
1. Total gallons purchased
with the excise tax paid
(round to whole gallons). . . .
2. Excise tax rate . . . . . . . . . . .
X
$0.16
X
$0.19
X
$0.095
X
$0.035
3. Refund Total
(line 1 multiplied by line 2) . .
I declare under the penalties of perjury that this claim has been examined by me and to the best of my knowledge and belief is true and
correct, and that the number of gallons claimed were purchased by the exempt entity with the excise tax paid, and that said petitioner is
entitled to such refund under the provisions of Section 40-17-329(e).
Signature: _________________________________________________________________ Date: ____________________________
Title or Position: ______________________________________________________________________________________________
Records to clearly substantiate the above petition must be maintained by the exempt entity for a period of six years and must be made
available to the Alabama Department of Revenue or its authorized agents upon request. The statute of limitations is two years from the
date the purchase was made by the exempt entity. The petition must be filed on a quarterly basis with a separate petition for each
quarter and cannot include any sales for any other period. Copies of receipts/invoices or a credit card company report of purchases
stating the date of the purchase made by the exempt entity, vendor name and location, invoice number, product type, and number of
gasoline, undyed diesel fuel, aviation gasoline, and jet fuel gallons must be attached to the petition for refund. Please see instructions
for further details.
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