Form Dr-138 Draft - Application For Fuel Tax Refund Agricultural, Aquacultural, Commercial Fishing Or Commercial Aviation Purposes
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3DR-138
Application for Fuel Tax Refund
R. 01/18
Agricultural, Aquacultural, Commercial Fishing or
Commercial Aviation Purposes
Rule 12B-5.150
Florida Administrative Code
For the Quarter Ending
Effective 01/18
Check here if amending
Mail To:
Florida Department of Revenue
Refunds
P.O. Box 6490
Tallahassee, FL 32314-6490
For Help Call: 850-617-8585
Permit #:
FEIN:
Business Partner #:
Gallons
Gasoline/Gasohol
Part I – Gasoline, Gasohol
,
,
.
1.
Beginning inventory (Must agree with closing inventory from prior quarter) ..........................
,
,
.
2.
Gallons purchased ("Schedule of Purchases" attached) ........................................................
,
,
.
3.
Closing inventory (Use this figure for beginning inventory on next claim) ..............................
,
,
.
Total consumption (Add Lines 1 and 2. Subtract Line 3) .......................................................
4.
,
,
.
5.
Gallons not eligible for refund (Highway use, pleasure fishing) .............................................
6.
Gallons claimed for refund (Subtract Line 5 from Line 4)
..............................................................
,
,
.
(A) Refund for Agricultural, Aquacultural, or Commercial Fishing Purposes (Line 6 X .141)
7.
(B) Refund for Commercial Aviation Purpose
(Line 6 X .131) ...............................................
s
$
,
,
.
See item eight on reverse page if any of the gallons claimed on Line 6 were purchased during the previous calendar year.
Part II – Local Option Tax and State Comprehensive Enhanced Transportation System (SCETS) Tax
This section to be used by those permit holders located in counties levying the local option tax as provided in s. 336.025, Florida Statutes
(F.S.) and the SCETS tax imposed according to s. 206.41(1)(f), F.S. Current local option and SCETS tax rates are available through our Internet
site at: , then select Fuel Rate Tax Information Publications.
1. Total gallons purchased and used subject to refund
,
,
.
(Must not exceed gallons claimed in Part I, Line 6)
2. Rate of tax levied:
Gasoline/Gasohol ________________________________ Cent(s)
$
,
,
.
3. Amount of tax claimed for refund (Line 1 X Line 2).......................................................
Net Refund Due (Add Part I, Line 7(A) or 7(B) plus Part II, Line 3)
$
,
,
.
No refund will be issued for less than $5.00.
Under penalty of perjury, I declare that I have read this application and the facts stated in it are true.
____________________________________________
__________________________________________
Signature of Applicant
Contact Person
____________________________________________
__________________________________________
Print/Type Applicant Name
Contact Telephone Number
____________________________________________
__________________________________________
Date
Contact Email address
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