Form GT-9A-B "Gasoline Refund Application for Those Engaged in the Business of Farming" - Massachusetts

What Is Form GT-9A-B?

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

Form Details:

  • Released on March 1, 2015;
  • The latest edition provided by the Massachusetts 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 GT-9A-B by clicking the link below or browse more documents and templates provided by the Massachusetts Department of Revenue.

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Download Form GT-9A-B "Gasoline Refund Application for Those Engaged in the Business of Farming" - Massachusetts

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Massachusetts Department of Revenue
Form GT-9A-B
Gasoline Refund Application for
Those Engaged in the Business of Farming
MGL Ch. 64A, sec. 7A — for transactions occurring on or after July 31, 2013
Applicant must answer all items or application will be returned. Mail to: Mass. Department of Revenue, PO Box 7012, Boston, MA 02204.
Name of applicant
Federal Identification number
Social Security number
Mailing address
Phone number
City/Town
State
Zip
Type of farming (stock, nursery, dairy, etc.)
Number of acres under cultivation
Fill in if you have storage facilities for fuel
Storage capacity (in gallons)
Date of first fuel purchase (mm/dd/yyyy)
Date of last fuel purchase (mm/dd/yyyy)
Fill in if you owe any Massachusetts state taxes
Fill in if you have applied for other motor fuel refunds (if Yes, list type(s))
Tax Refund Computation.
First in/first out basis must be used. Enter fuel as whole gallons.
a.
b.
c.
d.
Jan. 1–March 31
April 1–June 30
July 1–Sept. 30
Oct. 1–Dec. 31
11 Gallons of gasoline on hand at beginning
of each period . . . . . . . . . . . . . . . . . . . . . 1
12 Gasoline purchased each period. . . . . . . 2
13 Add lines 1 and 2 . . . . . . . . . . . . . . . . . . . 3
14 Gasoline on hand at close of business
of each period . . . . . . . . . . . . . . . . . . . . . 4
15 Gasoline to be accounted for. Subtract
line 4 from line 3. . . . . . . . . . . . . . . . . . . . 5
16 Gasoline used over highway (from
reverse) . . . . . . . . . . . . . . . . . . . . . . . . . . 6
17 Gasoline used for non-highway purposes
(from reverse). . . . . . . . . . . . . . . . . . . . . . 7
.24
.24
.24
.24
18 Excise tax rate per gallon. . . . . . . . . . . . . 8
19 Excise tax refund for each period.
Multiply line 7 by line 8. . . . . . . . . . . . . . . 9
10 Total amount to be refunded. Add line 9, columns. a, b, c and d . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Schedule on reverse must be completed in its entirety.
Application subject to audit. Purchase receipts and complete distribution records of all gasoline used must be kept three years for verification by a
representative of the Commissioner. Claims based on estimates are not acceptable.
Claims for refund of tax based on gasoline used during the taxable year must be filed on or before the 15th day of the fourth month following the close
of such taxable year. If the taxable year and calendar year coincide, the application must be filed on or before April 15.
Declaration
The undersigned applicant states under the penalties of perjury that all information contained in this application is true, correct and complete
and that the undersigned has complied with all laws of the Commonwealth relating to taxes.
Signature of applicant or person authorized to sign
Date
Rev. 3/15
Massachusetts Department of Revenue
Form GT-9A-B
Gasoline Refund Application for
Those Engaged in the Business of Farming
MGL Ch. 64A, sec. 7A — for transactions occurring on or after July 31, 2013
Applicant must answer all items or application will be returned. Mail to: Mass. Department of Revenue, PO Box 7012, Boston, MA 02204.
Name of applicant
Federal Identification number
Social Security number
Mailing address
Phone number
City/Town
State
Zip
Type of farming (stock, nursery, dairy, etc.)
Number of acres under cultivation
Fill in if you have storage facilities for fuel
Storage capacity (in gallons)
Date of first fuel purchase (mm/dd/yyyy)
Date of last fuel purchase (mm/dd/yyyy)
Fill in if you owe any Massachusetts state taxes
Fill in if you have applied for other motor fuel refunds (if Yes, list type(s))
Tax Refund Computation.
First in/first out basis must be used. Enter fuel as whole gallons.
a.
b.
c.
d.
Jan. 1–March 31
April 1–June 30
July 1–Sept. 30
Oct. 1–Dec. 31
11 Gallons of gasoline on hand at beginning
of each period . . . . . . . . . . . . . . . . . . . . . 1
12 Gasoline purchased each period. . . . . . . 2
13 Add lines 1 and 2 . . . . . . . . . . . . . . . . . . . 3
14 Gasoline on hand at close of business
of each period . . . . . . . . . . . . . . . . . . . . . 4
15 Gasoline to be accounted for. Subtract
line 4 from line 3. . . . . . . . . . . . . . . . . . . . 5
16 Gasoline used over highway (from
reverse) . . . . . . . . . . . . . . . . . . . . . . . . . . 6
17 Gasoline used for non-highway purposes
(from reverse). . . . . . . . . . . . . . . . . . . . . . 7
.24
.24
.24
.24
18 Excise tax rate per gallon. . . . . . . . . . . . . 8
19 Excise tax refund for each period.
Multiply line 7 by line 8. . . . . . . . . . . . . . . 9
10 Total amount to be refunded. Add line 9, columns. a, b, c and d . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Schedule on reverse must be completed in its entirety.
Application subject to audit. Purchase receipts and complete distribution records of all gasoline used must be kept three years for verification by a
representative of the Commissioner. Claims based on estimates are not acceptable.
Claims for refund of tax based on gasoline used during the taxable year must be filed on or before the 15th day of the fourth month following the close
of such taxable year. If the taxable year and calendar year coincide, the application must be filed on or before April 15.
Declaration
The undersigned applicant states under the penalties of perjury that all information contained in this application is true, correct and complete
and that the undersigned has complied with all laws of the Commonwealth relating to taxes.
Signature of applicant or person authorized to sign
Date
Rev. 3/15
2015 FORM GT-9A-B, PAGE 2
Name of applicant
Federal Identification number
Social Security number
Name of vendor from whom gasoline was purchased
Gallons purchased
Street address of vendor
City/Town
State
Zip
Complete below if application includes gasoline used by custom operators on your farm.
Name of operator
Street address of operator
City/Town
State
Zip
Name of operator
Street address of operator
City/Town
State
Zip
Name of operator
Street address of operator
City/Town
State
Zip
Equipment information.
List all equipment (registered and unregistered) in which gasoline was used. Itemize gallonage consumed in
each piece of equipment (records must be kept to substantiate total gallonage). Attach additional sheets if needed.
Registration number
– Gallons –
(farmplate or auto and
a.
b.
Type of equipment
truck license plate number)
Highway use
Non-highway use
Total gallons. Enter col. a in page 1, line 6; enter col. b in page 1, line 7 . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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