"Underground Storage Tank Tax Refund Request Form" - Arizona

The Arizona Department of Environmental Quality has released this version of the "Underground Storage Tank Tax Refund Request Form" on April 19, 2018.

This form may be used by all Arizona residents: download the printable PDF by clicking the link below and use it according to the applicable legal guidelines.

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Download "Underground Storage Tank Tax Refund Request Form" - Arizona

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AZ DEPT OF ENVIRONMENTAL QUALITY
UST INFORMATION SUPPORT UNIT
1110 WEST WASHINGTON STREET
PHOENIX, AZ 85007-2935
602.771.4384 or USTTaxesFees@azdeq.gov
TOLL FREE IN AZ 800.234.5677 EXT 7714384
UNDERGROUND STORAGE TANK TAX REFUND REQUEST CLAIM REQUIREMENTS
Any person who pays the tax but is not liable for the tax under Arizona Revised Statue Title 49, Chapter 6 may claim a refund of the tax paid. A claim for a refund shall be
submitted on the
Underground Storage Tank Tax Refund Request
Form. If the Department determines that a person claiming a refund is entitled to the refund, the
Department shall issue a refund. Any person eligible to claim a refund of the tax may
assign
the claim to the person from whom the regulated substance was purchased.
Any person submitting a claim for a refund, must submit the following:
1. A completed
Underground Storage Tank Tax Refund Request
Form.
2. Invoice showing the tax billed
 Submit clean, readable invoices (no more than 30 invoices per claim) clearly showing the UST tax of .01 per gallon has been charged. The invoices must also
show vendor name, facility location, invoice number, invoice date and total fuel purchased for each product. PDF or electronic copies are not acceptable.
3. Supporting documentation showing tax paid
 Submit proof of payment showing the supplier was paid for each invoice via an accounting EFT transaction report. The report should clearly display the invoice
number, transaction date and amount paid. Highlight the tax paid on the EFT transaction report in order to assist in processing your claims in a timely manner.
rd
rd
4. If a facility has both underground and aboveground (or vaulted tanks) that contain the same product, you must submit a 3
party report. The 3
party report
rd
must show the contact name and phone number of the entity supplying the report on their company letterhead. The 3
party report must also display the invoice
number, delivery date, product type and number of gallons purchased in the exempt tank. Highlighting these on the report may expedite the claim processing.
Please be advised that incomplete forms and/or lack of required additional documentation will result in the claim being returned to the submitter.
UST TAX EXEMPTION REASON
FUEL PRODUCT CODES
CODE
01
Tribal Land Tank
CODE
TAXABLE PRODUCT TYPE
CODE
TAXABLE PRODUCT TYPE
02
State-Owned Tank
10
Gasoline (list type)
60
Used Oil
03
Federally-Owned Tank
20
Diesel (list type)
70
Other – please specify
10
Aboveground Storage Tank
30
Oxygenated Gasoline
80
CERCLA Hazardous Waste
11
Vaulted Tank
40
Kerosene
110
Aviation Gasoline
21
Farm Tank less than 1,100 gallons used for noncommercial purposes
50
Bio-Diesel
120
New Oil
22
Residential Tank of less than 1,100 gallons used for noncommercial purposes
30
Naptha-Type or Kerosene-Type Jet fuel storage
DEQ prefers the Underground Storage Tank Tax Refund Request Form and supporting documentation to be submitted in hard copy format to 1110 West Washington
Street (4415 A- 3), Phoenix Arizona 85007-2935. Inquiries for the UST Tax Refund process may be directed to Catherine Callahan at (602) 771-4384 or toll free in the state
of Arizona at 800.234.5677, extension 7714384, or by email at
USTTaxesFees@azdeq.gov.
Revised 4-19-18
AZ DEPT OF ENVIRONMENTAL QUALITY
UST INFORMATION SUPPORT UNIT
1110 WEST WASHINGTON STREET
PHOENIX, AZ 85007-2935
602.771.4384 or USTTaxesFees@azdeq.gov
TOLL FREE IN AZ 800.234.5677 EXT 7714384
UNDERGROUND STORAGE TANK TAX REFUND REQUEST CLAIM REQUIREMENTS
Any person who pays the tax but is not liable for the tax under Arizona Revised Statue Title 49, Chapter 6 may claim a refund of the tax paid. A claim for a refund shall be
submitted on the
Underground Storage Tank Tax Refund Request
Form. If the Department determines that a person claiming a refund is entitled to the refund, the
Department shall issue a refund. Any person eligible to claim a refund of the tax may
assign
the claim to the person from whom the regulated substance was purchased.
Any person submitting a claim for a refund, must submit the following:
1. A completed
Underground Storage Tank Tax Refund Request
Form.
2. Invoice showing the tax billed
 Submit clean, readable invoices (no more than 30 invoices per claim) clearly showing the UST tax of .01 per gallon has been charged. The invoices must also
show vendor name, facility location, invoice number, invoice date and total fuel purchased for each product. PDF or electronic copies are not acceptable.
3. Supporting documentation showing tax paid
 Submit proof of payment showing the supplier was paid for each invoice via an accounting EFT transaction report. The report should clearly display the invoice
number, transaction date and amount paid. Highlight the tax paid on the EFT transaction report in order to assist in processing your claims in a timely manner.
rd
rd
4. If a facility has both underground and aboveground (or vaulted tanks) that contain the same product, you must submit a 3
party report. The 3
party report
rd
must show the contact name and phone number of the entity supplying the report on their company letterhead. The 3
party report must also display the invoice
number, delivery date, product type and number of gallons purchased in the exempt tank. Highlighting these on the report may expedite the claim processing.
Please be advised that incomplete forms and/or lack of required additional documentation will result in the claim being returned to the submitter.
UST TAX EXEMPTION REASON
FUEL PRODUCT CODES
CODE
01
Tribal Land Tank
CODE
TAXABLE PRODUCT TYPE
CODE
TAXABLE PRODUCT TYPE
02
State-Owned Tank
10
Gasoline (list type)
60
Used Oil
03
Federally-Owned Tank
20
Diesel (list type)
70
Other – please specify
10
Aboveground Storage Tank
30
Oxygenated Gasoline
80
CERCLA Hazardous Waste
11
Vaulted Tank
40
Kerosene
110
Aviation Gasoline
21
Farm Tank less than 1,100 gallons used for noncommercial purposes
50
Bio-Diesel
120
New Oil
22
Residential Tank of less than 1,100 gallons used for noncommercial purposes
30
Naptha-Type or Kerosene-Type Jet fuel storage
DEQ prefers the Underground Storage Tank Tax Refund Request Form and supporting documentation to be submitted in hard copy format to 1110 West Washington
Street (4415 A- 3), Phoenix Arizona 85007-2935. Inquiries for the UST Tax Refund process may be directed to Catherine Callahan at (602) 771-4384 or toll free in the state
of Arizona at 800.234.5677, extension 7714384, or by email at
USTTaxesFees@azdeq.gov.
Revised 4-19-18
AZ DEPT OF ENVIRONMENTAL QUALITY
UST INFORMATION SUPPORT UNIT
1110 WEST WASHINGTON STREET
PHOENIX, AZ 85007-2935
602.771.4384 or USTTaxesFees@azdeq.gov
TOLL FREE IN AZ 800.234.5677 EXT 7714384
Underground Storage Tank Tax Refund Request
1 Applicant Information
2 Facility Information
Tank Owner Name
Facility Name
Mailing Address
Mailing Address
(No PO Box)
City
State
ZIP Code
City
State
ZIP Code
Contact Phone #
Email Address
Contact Phone #
Email Address
3. Exemption Certificate Number: _________________________________________
4. Enter the applicable information below
(One row per supplier)
Fuel Provider
Fuel Type
Gallons
Refund Claimed
Purchased
UST Tax Paid
TOTAL REFUND REQUESTED →
5 Certification Statement
I certify under penalty of perjury that I have personally examined and am familiar with the information
submitted in this and all attached documents and that the submitted information is true, accurate and complete
Signature of Applicant
Date of Signature
FOR STATE USE ONLY
Total Refund Approved by ADEQ: _______________________________________________________________________________________________________
If grand total of refund differs from amount requested – check appropriate reason:
□ Invoice tax less than 3rd Party Report
□ 3
Party Report tax less than invoice tax
rd
□ Duplicate invoices submitted
□ Invoices missing
□ Reported calculations incorrect
Revised Sept 2017
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