Form MC45-G "Motor Fuel Tax Refund Request Form" - Nevada

What Is Form MC45-G?

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 January 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 MC45-G 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 MC45-G "Motor Fuel Tax Refund Request Form" - Nevada

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MOTOR CARRIER DIVISION
555 WRIGHT WAY
CARSON CITY, NV 89711-0600
(775) 684-4711
fax (775) 684-4619
http://www.dmvnv.com/mcforms.htm
Motor Fuel Tax Refund Request Form (MC45-G)
PART-1 IDENTIFYING INFORMATION:
/
/
/
/
Nevada Account Number
Period Beginning
Period Ending
Account Name
Federal Employer Identification Number (FEIN)
Business Mailing Address
City
State
Zip
Location of Records Address (if different from above)
Email Address
Contact Person (Name/Telephone Number)
Indicate type of fuel claimed for a refund (use a separate claim form for each fuel type/County):
Gasoline
Gasohol
E85 (Complete and attach Part 2 Motor Vehicle Fuel)
How was fuel purchased?
Bulk (Must complete bulk fuel information)
Purchased at the pump (Must provide receipts)
Total Refund Requested: _________________________
Under penalties of perjury, I declare that, as taxpayer or preparer, I have examined this refund request form, including the documentation attached,
and to the best of my knowledge and belief, it is true, correct and complete. All refund claims are subject to audit.
Printed Name of Taxpayer
Printed Name of Preparer if other Than Taxpayer
Signature of Taxpayer
Signature of Preparer if other than taxpayer
Title
Title
(
)
(
)
Telephone
Date
Telephone
Date
Attachments:
Equipment List
Original Fuel Receipts
Bulk Fuel Inventory List
Other __________
_________________________________________________________________________________________________
For Department Use Only
Postmark Date: ____________________
Received by: ___________ Date: _________________ Returned for correction by: __________ Date: ___________
Processed by: ____________ Date: _________________
Amount of Refund Processed: ______________________
MC045G (REV1/2016)
Page 1 of 4
MOTOR CARRIER DIVISION
555 WRIGHT WAY
CARSON CITY, NV 89711-0600
(775) 684-4711
fax (775) 684-4619
http://www.dmvnv.com/mcforms.htm
Motor Fuel Tax Refund Request Form (MC45-G)
PART-1 IDENTIFYING INFORMATION:
/
/
/
/
Nevada Account Number
Period Beginning
Period Ending
Account Name
Federal Employer Identification Number (FEIN)
Business Mailing Address
City
State
Zip
Location of Records Address (if different from above)
Email Address
Contact Person (Name/Telephone Number)
Indicate type of fuel claimed for a refund (use a separate claim form for each fuel type/County):
Gasoline
Gasohol
E85 (Complete and attach Part 2 Motor Vehicle Fuel)
How was fuel purchased?
Bulk (Must complete bulk fuel information)
Purchased at the pump (Must provide receipts)
Total Refund Requested: _________________________
Under penalties of perjury, I declare that, as taxpayer or preparer, I have examined this refund request form, including the documentation attached,
and to the best of my knowledge and belief, it is true, correct and complete. All refund claims are subject to audit.
Printed Name of Taxpayer
Printed Name of Preparer if other Than Taxpayer
Signature of Taxpayer
Signature of Preparer if other than taxpayer
Title
Title
(
)
(
)
Telephone
Date
Telephone
Date
Attachments:
Equipment List
Original Fuel Receipts
Bulk Fuel Inventory List
Other __________
_________________________________________________________________________________________________
For Department Use Only
Postmark Date: ____________________
Received by: ___________ Date: _________________ Returned for correction by: __________ Date: ___________
Processed by: ____________ Date: _________________
Amount of Refund Processed: ______________________
MC045G (REV1/2016)
Page 1 of 4
PART-2 MOTOR VEHICLE FUELS (GASOLINE, GASOHOL, E85 ONLY)
Refund is claimed for non-highway use of Gasoline, Gasohol and/or E85 as indicated:
Contracting
Well Drilling
Railroads
Other Specify
Mining
INVOICE
INVOICE
NUMBER OF
INVOICE
INVOICE
NUMBER OF
NUMBER
DATE
GALLONS
NUMBER
DATE
GALLONS
PURCHASED
PURCHASED
GASOLINE/GASOHOL/E85 ONLY
.2646 – .3136
Total Refund
Cents
1 Cent Tax
Claim
(State/County)
Enter County in
Total gallons purchased
which the fuel was
Less gallons for highway use
taxed (purchased):
Total gallons claimed for refund
Rate of refund (from matrix)
.0098
________________
Motor Vehicle Fuel Refund Amount
NOTE: Submit a separate claim for each county where fuel was purchased and you are claiming a refund of the tax paid. All
gallons must be rounded to the nearest whole gallon.
IMPORTANT NOTICE: Please review the following table as various county rates may have changed.
EFFECTIVE RATES
Motor Fuel Rate Matrix
Current Tax Rates as of
County
2/1/2016
01 Carson City
.3136
02 Churchill
.3136
03 Clark
.3136
04 Douglas
.3136
05 Elko
.3136
06 Esmeralda
.2646
07 Eureka
.2646
08 Humboldt
.3136
09 Lander
.3136
10 Lincoln
.2646
11 Lyon
.3136
12 Mineral
.3136
13 Nye
.3136
14 Pershing
.3136
15 Storey
.2646
16 Washoe
.3136
17 White Pine
.3136
MC045G (REV1/2016)
Page 2 of 4
Attachment A - Equipment List
Description of equipment, make, unit
Purpose for which used
License
Equipment Type: (i.e., Generator,
number
Plate #
Lawn Mower, Farm Equipment, Etc.)
MC045G (REV1/2016)
Page 3 of 4
Attachment B - Bulk Fuel – Must be completed if bulk fuel is maintained.
Brief description of business operations: ________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
Number of Bulk Fuel Tank(s) ________ Capacity of each tank ______________________________
(Please attach a bulk tank inventory sheet to correspond with this claim for each bulk tank)
Physical location of bulk fuel tank(s) ____________________________________________________
Are Tank(s) Metered?
Yes*
No
*If yes, are they located above ground?
Yes
No
Are bulk tank and fuel truck tank logs maintained with the number of gallons specified by equipment
number?
Yes
No
Are bulk tank inventories reconciled?
Yes*
No *If yes,
Daily
Monthly
Quarterly
Are odometer readings recorded for highway use vehicles?
Yes*
No
*If yes,
Daily
Monthly
Quarterly
Please list the suppliers from whom you purchase fuel________________________________________
_________________________________________________________________________________
Bulk Fuel Inventory – Please report in total Gallons by tank and fuel type.
Tank 1 – List Fuel Type
_____________
Tank 2 – List Fuel Type
______________
Beginning Inventory
_____________
Beginning Inventory
______________
Total Purchases
+ _____________
Total Purchases
+ ______________
Ending Inventory
- _____________
Ending Inventory
- ______________
Gain/Loss
- _____________
Gain/Loss
- ______________
Gallons Dispensed
= _____________
Gallons Dispensed
= ______________
Tank 3 – List Fuel Type
_____________
Tank 4 – List Fuel Type
______________
Beginning Inventory
_____________
Beginning Inventory
______________
Total Purchases
+ _____________
Total Purchases
+ ______________
Ending Inventory
- _____________
Ending Inventory
- ______________
Gain/Loss
- _____________
Gain/Loss
- ______________
Gallons Dispensed
= _____________
Gallons Dispensed
= ______________
Total Bulk Gasoline Dispensed
________________
Total Bulk Gasohol Dispensed
________________
Total Bulk E-85 Dispensed
________________
MC045G (REV1/2016)
Page 4 of 4
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