Form 04-544 - Claim For Refund Motor Fuel Tax - Alaska Department Of Revenue (Page 3 of 4) in pdf

Form 04-544 - Claim For Refund Motor Fuel Tax - Alaska Department Of Revenue Page 3

Alaska Department of Revenue

Claim for Refund

Schedule of Non-Highway Motor Fuel Use

Range of Dates for Fuel Purchased

Name:____________________________________________

From:

EIN:

____________________________________________

To:

Fuel Type: (Check only one box)

DESCRIPTION OF EQUIPMENT.

First refund claim. If this is your first Claim for Refund this calendar

65 Gasoline

year, list below all equipment (including non-licensed vehicles) that use

124 Gasohol

motor fuel. If you prefer, attach a separate list and use this schedule only

for the equipment that used fuel for which you are now claiming a refund.

125 Aviation Gasoline

Subsequent refund claims. If you have already filed a Claim for

Refund this calendar year, list below only the equipment that used

130 Jet Fuel

fuel for which you are now claiming a refund.

160 Diesel

PURPOSE OF USE. Describe the manner in which the fuel was used;

File a separate form to report each type of fuel.

i.e. road construction, mining, etc. Complete this column only for

equipment that used fuel for which you are now claiming a refund.

Note: Do not include fuel used in a licensed motor vehicle.

Serial

Number of

Number

Purpose of Use

Gallons

Description of Equipment

Total Gallons (Carry forward to page 1, line 18)

Attach this schedule to your Claim for Refund. Use additional sheets as necessary.

Form 04-544.2 (Rev 04/01)

Form 04-544 - Claim For Refund Motor Fuel Tax - Alaska Department Of Revenue Page 3