Form DR-190 "Application for Fuel Tax Refund Non-public Schools - Sample" - Florida

What Is Form DR-190?

This is a legal form that was released by the Florida Department of Revenue - a government authority operating within Florida. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on January 1, 2020;
  • The latest edition provided by the Florida Department of Revenue;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form DR-190 by clicking the link below or browse more documents and templates provided by the Florida Department of Revenue.

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Download Form DR-190 "Application for Fuel Tax Refund Non-public Schools - Sample" - Florida

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Application for Fuel Tax Refund
DR-190
R. 01/20
Non-Public Schools
Rule 12B-5.150, F.A.C.
Effective 01/20
For the Quarter Ending
Page 1 of 3
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 #:
Column A
Column B
Gasoline, Gasohol, and
Gallons
Undyed Diesel Fuel
Gasoline/Gasohol
Undyed Diesel
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) .......
4. Total consumption (Add Lines 1 and 2.
,
,
.
,
,
.
Subtract Line 3) .....................................
5. Gallons not eligible for refund
,
,
.
,
,
.
(Off-road use) ........................................
6. Gallons claimed for refund (Subtract
,
,
.
,
,
.
Line 5 from Line 4) ................................
$
,
,
.
$
,
,
.
7. Refund (Lines 6A and 6B X .131) .........
See item eight on reverse page if any of the gallons claimed on Line 6 were purchased during the previous calendar year.
Net Refund Due (Add Lines 7A and 7B)
$
,
,
.
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
Application for Fuel Tax Refund
DR-190
R. 01/20
Non-Public Schools
Rule 12B-5.150, F.A.C.
Effective 01/20
For the Quarter Ending
Page 1 of 3
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 #:
Column A
Column B
Gasoline, Gasohol, and
Gallons
Undyed Diesel Fuel
Gasoline/Gasohol
Undyed Diesel
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) .......
4. Total consumption (Add Lines 1 and 2.
,
,
.
,
,
.
Subtract Line 3) .....................................
5. Gallons not eligible for refund
,
,
.
,
,
.
(Off-road use) ........................................
6. Gallons claimed for refund (Subtract
,
,
.
,
,
.
Line 5 from Line 4) ................................
$
,
,
.
$
,
,
.
7. Refund (Lines 6A and 6B X .131) .........
See item eight on reverse page if any of the gallons claimed on Line 6 were purchased during the previous calendar year.
Net Refund Due (Add Lines 7A and 7B)
$
,
,
.
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
Important Information Concerning Application for Fuel Tax Refund
DR-190
Non-Public Schools Claim
R. 01/20
Page 2 of 3
A Power of Attorney, Florida Department of Revenue Form DR-835, must be properly
executed and included if this application is prepared by your representative.
1.
Permit holders are entitled to a refund of the fuel sales tax
B. Department of Environmental Protection storage tank
levied under sections (ss.) 206.41(1)(g) and 206.87(1)(e) of
facility identification number of the tank where the
Chapter 206, Florida Statutes (F.S.), on gasoline, gasohol,
motor fuel was stored prior to purchase or the federal
and undyed diesel fuel purchased. The applicable tax
employee identification number of the seller.
rates are entered by the Department and are published
C. Type of motor fuel you purchased using the product
annually in Tax Information Publications and posted on the
types listed at the top of the schedules.
Department's website at
floridarevenue.com/taxes/rates.
D. Sales invoice number.
2.
Applications are to be used only for the quarter indicated
E. Date that you took possession of the motor fuel from
on the face of this application. Only original refund
the supplier (must be within this calendar quarter).
applications are acceptable. Application forms may be
F. County in which you took possession of the motor fuel
requested from the Department's Refund section at
from the supplier.
850-617-8585.
G. Total price you paid for the motor fuel purchased.
3.
Refund permits are renewed on an annual basis only if the
permit holder files quarterly claims during the year.
H. Number of gallons of motor fuel you purchased.
4.
Claim must be filed quarterly, no later than the last day of
7.
In the event of overpayment of any refund, the
the month immediately following the end of the quarter.
Department of Revenue will refuse to make further
The filing date may be extended one additional month
refunds and advise the payee of the amount to be
when a justified excuse is submitted in writing and the last
reimbursed.
preceding claim was filed timely.
8. Gallons that you purchased during the previous year and
With A Written
Purchases Made
Claims Must Be
consumed during the current quarter will not be eligible
Excuse -
During
Filed By *
for the full refundable rate for the current year. Instead,
No Later Than
these gallons should be multiplied by last year’s rate. This
January, February,
adjustment will compensate for any inventory that was
April 30
May 31
and March
assessed at last year’s rate and carried forward to the
April, May, and
current calendar year.
July 31
August 31
June
July, August, and
October 31
November 30
September
Line-by-Line Instructions
October, November,
January 31
February 28
and December
Purchases of Gasoline, Gasohol, and Undyed Diesel Fuel.
*Amended application for prior quarter must be received
Line 1. Beginning Inventory – Must be the same as
by current quarter’s deadline. Example: You must submit
your closing inventory from the prior quarter.
an amended March quarterly application by July 31.
If the prior quarter’s claim was not filed, enter
5.
Each permit holder must maintain records to substantiate:
zero.
• Fuel was used by a qualified applicant
Line 2. Gallons Purchased – This represents fuel you
• Fuel taxes were paid on the refundable gallons
purchased during the calendar quarter.
• Gallons reported as Beginning and Ending Inventory
These purchases must be supported
• Fuel was used in an eligible manner
by the Schedule of Purchases (Page 3).
When copies of your records are required to determine
Line 3. Closing Inventory – Actual physical
the amount of refund due, the Department will issue a
inventory as of the last day of the
written request to you within 30 days of the receipt of
quarter printed on Page 1. This will
your application. Your application for a refund is not
be your beginning inventory for the
complete until the requested records are received by the
next quarter. If no refund is due but a
Department.
closing inventory exists, the claim form
must be filed.
6.
The Schedule of Purchases (Page 3), detailing the
information listed below, may be submitted instead of
Line 4. Total Consumption – Line 1 plus Line 2
original invoices. Include only one product type listed
minus Line 3.
at the top of the Schedule of Purchases. Separate
Line 5. Gallons not eligible for refund – This
schedules must be used for each product type. However,
represents fuel purchased which was
first time filers of this form must submit tax paid invoices
used for “off-road” purposes.
with their initial refund request.
Line 6. Gallons claimed for refund – This
A. Name and address of supplier that you purchased
represents fuel used in a motor vehicle
motor fuel from.
operated by the permit holder.
Page of 3