Form MC058 "Farmer/Rancher Gasoline/Diesel Fuel Tax Refund Permit Application" - Nevada

What Is Form MC058?

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

Form Details:

  • Released on April 1, 2016;
  • The latest edition provided by the Nevada Department of Motor Vehicles;
  • 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 fillable version of Form MC058 by clicking the link below or browse more documents and templates provided by the Nevada Department of Motor Vehicles.

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Download Form MC058 "Farmer/Rancher Gasoline/Diesel Fuel Tax Refund Permit Application" - Nevada

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MOTOR CARRIER DIVISION
555 WRIGHT WAY
CARSON CITY, NV 89711-0600
(775) 684-4711
fax (775) 684-4619
www.dmvnv.com
For Office Use Only
Date Received
Date Approved
Date Issued
Initials
Account Number
FARMER/RANCHER GASOLINE/DIESEL FUEL TAX REFUND PERMIT APPLICATION
Any bona fide farmer or rancher requesting to claim a refund on fuel tax on the basis of 80% of bulk purchases without the
necessity of maintaining records of use, must first secure a permit from the department. Bulk purchases means
purchases in excess of 50 gallons of fuel which are not placed directly into the tanks of motor vehicles.
If there is a change in location of your operations, sale of property, new owner, new operator, change of partnership or
officers of the corporation a new application must be filed with the Department of Motor Vehicles.
Applicant’s Name (type or print) _________________________________________FEIN/SSN______________________
Physical Address
___________________________________________________________________________________
Mailing Address (if different) __________________________________________________________________________
City, State, Zip Code ________________________________________________________________________________
Daytime Phone Number (______)_____________________________________________________________________
Email Address _____________________________________________________________________________________
Answer all questions:
1.
Is this operation an individual ________ partnership ________ corporation ________
List partners, or officers of corporation ______________________________________________________________
______________________________________________________________________________________________
2.
Total number of acres in use for farming and/or ranching _____________
Acres
Acres
Acres
Alfalfa
Pasture
Cultivated
Wild Hay
Grazing
Other
Other explain:
3.
List type of livestock:
_________________________________________________________________________
4.
Do you have other employment: __________ If yes, explain: ________________________________________
5.
If the answer to 4 is yes, list the number of days per year _____________________________________________
6.
Is all your farming or ranching property located together? Yes  No 
If no, give details
_____________________________________________________________________________
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MC058 (04/2016)
MOTOR CARRIER DIVISION
555 WRIGHT WAY
CARSON CITY, NV 89711-0600
(775) 684-4711
fax (775) 684-4619
www.dmvnv.com
For Office Use Only
Date Received
Date Approved
Date Issued
Initials
Account Number
FARMER/RANCHER GASOLINE/DIESEL FUEL TAX REFUND PERMIT APPLICATION
Any bona fide farmer or rancher requesting to claim a refund on fuel tax on the basis of 80% of bulk purchases without the
necessity of maintaining records of use, must first secure a permit from the department. Bulk purchases means
purchases in excess of 50 gallons of fuel which are not placed directly into the tanks of motor vehicles.
If there is a change in location of your operations, sale of property, new owner, new operator, change of partnership or
officers of the corporation a new application must be filed with the Department of Motor Vehicles.
Applicant’s Name (type or print) _________________________________________FEIN/SSN______________________
Physical Address
___________________________________________________________________________________
Mailing Address (if different) __________________________________________________________________________
City, State, Zip Code ________________________________________________________________________________
Daytime Phone Number (______)_____________________________________________________________________
Email Address _____________________________________________________________________________________
Answer all questions:
1.
Is this operation an individual ________ partnership ________ corporation ________
List partners, or officers of corporation ______________________________________________________________
______________________________________________________________________________________________
2.
Total number of acres in use for farming and/or ranching _____________
Acres
Acres
Acres
Alfalfa
Pasture
Cultivated
Wild Hay
Grazing
Other
Other explain:
3.
List type of livestock:
_________________________________________________________________________
4.
Do you have other employment: __________ If yes, explain: ________________________________________
5.
If the answer to 4 is yes, list the number of days per year _____________________________________________
6.
Is all your farming or ranching property located together? Yes  No 
If no, give details
_____________________________________________________________________________
Page 1 of 2
MC058 (04/2016)
7.
Give exact location of property and instructions for reaching it.
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
8.
Do you supply your licensed vehicles from your bulk fuel purchases? ___________
9.
List all gasoline-powered and/or all diesel-powered equipment owned by you (or the operating company). Start
with all licensed vehicles and trucks, giving license number and total estimated miles on highways per calendar
year. Then continue with unlicensed vehicles and gasoline-powered and/or diesel-powered equipment.
Type
Make
Year
License
Hwy
Horse-
Number
Miles
power
10.
Approximate number of gallons of fuel used in your operations per year ______________________________
Under penalties of perjury, the applicant declares the above statements are true to the best of the applicant’s knowledge and belief.
The applicant hereby applies for a permit from the Department of Motor Vehicles for the purpose of filing fuel tax refund claims on the
basis of 80% of bulk fuel purchases, without maintaining records of use, in accordance with Chapter 366, Nevada Revised Statutes.
The applicant understands that no more than 20% of the bulk fuel purchased is to be used in vehicles on highways and roads.
____________________________________________ Authorized signature
____________________________________________ Date
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MC058 (04/2016)
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