Form SCGR-1 "Gasoline Tax Refund Claim" - California

What Is Form SCGR-1?

This is a legal form that was released by the California State Controller’s Office - a government authority operating within California. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on April 1, 2018;
  • The latest edition provided by the California State Controller’s Office;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;

Download a fillable version of Form SCGR-1 by clicking the link below or browse more documents and templates provided by the California State Controller’s Office.

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Download Form SCGR-1 "Gasoline Tax Refund Claim" - California

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(Revised April 2018)
GASOLINE TAX REFUND CLAIM
FORM SCGR-1
State of California
Send completed forms to:
For SCO Use Only
ALL YEARS
California State Controller’s Office
Claim No./Received Date
Tax Administration Section
EXCEPT 2017
P.O. Box 942850
Sacramento, CA 94250-5880
STD. 204 Form on File First-Time Claimant 
Renewal Claimant 
Address Change SCO Account No.__________________
1.
Name of Company/Claimant _______________________________________________________________________ ___________________
Federal Tax ID No. / SSN
2.
Mailing Address
________________________________________________________________________________________________
Street Address
City
State
Zip
Location of Service ________________________________________________________________________________________________
3.
Street Address
City
State
Zip
4.
Contact Information: ______________________________ ____________________________ ___________________________
Phone Number - include area code
Name of Claimant or Responsible Party for Claim
E-mail Address
5.
Calendar Year __________
Filing Period:
From ___________________ To ____________________
(See instructions)
READ INSTRUCTIONS BEFORE PREPARING CLAIM – Type or Print Clearly
REFUNDABLE GALLONS / AMOUNT CLAIMED
GALLONS
DOLLARS
Refer to
www.sco.ca.gov/ardtax_gas_tax.html
for the current rate, or $0.06 if Paratransit
(Round to Whole Gallons)
………………………………………………………..__________
6.
FUEL PURCHASED
(Enter total from Schedule A)
(If the inventory method is used, enter the amount from Schedule D, Line 12)
___
7a. REFUNDABLE FUEL
prior to July 1st
.......................................................... __________
$____________
(Purchased and Used
)
(If the inventory method is used, enter the amount from Schedule D, Line 10) (enter gasoline portion only)
___
to Dec 31st)
7b. REFUNDABLE FUEL
st
................................................. __________
$____________
(Purchased and Used from July 1
(If the inventory method is used, enter the amount from Schedule D, Line 10) (enter gasoline portion only)
(Subtract lines 7a and 7b from line 6) ………………………………………..
8.
NON-REFUNDABLE FUEL
__________
(enter ethanol portion only)
9.
REFUND CLAIMED
$____________
....................................................................................................................................................................................................
10. Type of Operation (please indicate below):
  Individual Driving on a Military Installation:
 E-85 Blended Fuel Producer:
 Personal Vehicle  Government Vehicle
 Highway Use  Gas Station
  Export to other State (please indicate state): _____________
 Farm/Ranch: No. of acres __________
  Vessel used:
 Public Transportation/Paratransit:
 On private property
 Full Contract Included:
 Beyond 3 Mile Limit: (only claim gas used beyond 3 mile limit)
Contract Expires _______________
  Other (describe): ___________________________________________________________
(Attach additional information if needed)
11. Method Used to Determine Refundable Gallons: (see instructions)  Specific  Percentage  Inventory
(Schedule D required)
 Describe ________________________________________________________________________________________________
CERTIFICATION: Under penalty of perjury, I hereby certify that I have full knowledge of this claim, that the fuel was purcha sed and taxed in California on the dates and in the
amounts shown; that the fuel has been used in the manner indicated; that I am entitled to a refund based upon certain use of the fuel in accordance with California law, especially
Part 2 of Division 2, of the Revenue and Taxation Code. No refund has been requested for the gallons claimed prior to this date. All supporting documents will be maintained for a
period of not less than four (4) years from the date of refund issuance.
Claimant’s Signature
X
Title
Date
______________________________________
______________________________
________________________
(Job Title)
(Original Signature Required)
Preparer’s Name
Title
Phone
______________________________________
______________________________
____________________
(Job Title)
(If Different Than Claimant)
For SCO Use Only
Desk Audit Exception
County
SCO Date
Date
Industry
Desk Audit
By
Date
Sent for Field
Rates
Audit
To
Date
(Revised April 2018)
GASOLINE TAX REFUND CLAIM
FORM SCGR-1
State of California
Send completed forms to:
For SCO Use Only
ALL YEARS
California State Controller’s Office
Claim No./Received Date
Tax Administration Section
EXCEPT 2017
P.O. Box 942850
Sacramento, CA 94250-5880
STD. 204 Form on File First-Time Claimant 
Renewal Claimant 
Address Change SCO Account No.__________________
1.
Name of Company/Claimant _______________________________________________________________________ ___________________
Federal Tax ID No. / SSN
2.
Mailing Address
________________________________________________________________________________________________
Street Address
City
State
Zip
Location of Service ________________________________________________________________________________________________
3.
Street Address
City
State
Zip
4.
Contact Information: ______________________________ ____________________________ ___________________________
Phone Number - include area code
Name of Claimant or Responsible Party for Claim
E-mail Address
5.
Calendar Year __________
Filing Period:
From ___________________ To ____________________
(See instructions)
READ INSTRUCTIONS BEFORE PREPARING CLAIM – Type or Print Clearly
REFUNDABLE GALLONS / AMOUNT CLAIMED
GALLONS
DOLLARS
Refer to
www.sco.ca.gov/ardtax_gas_tax.html
for the current rate, or $0.06 if Paratransit
(Round to Whole Gallons)
………………………………………………………..__________
6.
FUEL PURCHASED
(Enter total from Schedule A)
(If the inventory method is used, enter the amount from Schedule D, Line 12)
___
7a. REFUNDABLE FUEL
prior to July 1st
.......................................................... __________
$____________
(Purchased and Used
)
(If the inventory method is used, enter the amount from Schedule D, Line 10) (enter gasoline portion only)
___
to Dec 31st)
7b. REFUNDABLE FUEL
st
................................................. __________
$____________
(Purchased and Used from July 1
(If the inventory method is used, enter the amount from Schedule D, Line 10) (enter gasoline portion only)
(Subtract lines 7a and 7b from line 6) ………………………………………..
8.
NON-REFUNDABLE FUEL
__________
(enter ethanol portion only)
9.
REFUND CLAIMED
$____________
....................................................................................................................................................................................................
10. Type of Operation (please indicate below):
  Individual Driving on a Military Installation:
 E-85 Blended Fuel Producer:
 Personal Vehicle  Government Vehicle
 Highway Use  Gas Station
  Export to other State (please indicate state): _____________
 Farm/Ranch: No. of acres __________
  Vessel used:
 Public Transportation/Paratransit:
 On private property
 Full Contract Included:
 Beyond 3 Mile Limit: (only claim gas used beyond 3 mile limit)
Contract Expires _______________
  Other (describe): ___________________________________________________________
(Attach additional information if needed)
11. Method Used to Determine Refundable Gallons: (see instructions)  Specific  Percentage  Inventory
(Schedule D required)
 Describe ________________________________________________________________________________________________
CERTIFICATION: Under penalty of perjury, I hereby certify that I have full knowledge of this claim, that the fuel was purcha sed and taxed in California on the dates and in the
amounts shown; that the fuel has been used in the manner indicated; that I am entitled to a refund based upon certain use of the fuel in accordance with California law, especially
Part 2 of Division 2, of the Revenue and Taxation Code. No refund has been requested for the gallons claimed prior to this date. All supporting documents will be maintained for a
period of not less than four (4) years from the date of refund issuance.
Claimant’s Signature
X
Title
Date
______________________________________
______________________________
________________________
(Job Title)
(Original Signature Required)
Preparer’s Name
Title
Phone
______________________________________
______________________________
____________________
(Job Title)
(If Different Than Claimant)
For SCO Use Only
Desk Audit Exception
County
SCO Date
Date
Industry
Desk Audit
By
Date
Sent for Field
Rates
Audit
To
Date