Form TC-69 Schedule FUEL "Fuel Tax Types" - Utah

What Is Form TC-69 Schedule FUEL?

This is a legal form that was released by the Utah State Tax Commission - a government authority operating within Utah.The document is a supplement to Form TC-69, Utah State Business and Tax Registration. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on June 1, 2019;
  • The latest edition provided by the Utah State Tax Commission;
  • 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 TC-69 Schedule FUEL by clicking the link below or browse more documents and templates provided by the Utah State Tax Commission.

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Download Form TC-69 Schedule FUEL "Fuel Tax Types" - Utah

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TC-69FUEL
TC-69 Schedule FUEL
Rev. 6/19
Fuel Tax Types
EIN/SSN: __ __ _ __ __ __ _
Fill out the section(s) that apply. Attach this schedule to your TC-69 form to register for any of the following:
• Fuel tax license (motor fuel, special fuel, aviation fuel, hydrogen, environmental assurance fee, CNG, LNG)
• International Fuel Tax Agreement
• Special Fuel User
To apply for IRP, use forms TC-852 and TC-899B.
Clear form
Print Form
Section 1 – Fuel License

1a.
Special Fuel Supplier
Effective date (mm/dd/yy): _________
Qualifications:
(Check all operations that apply to you. If none, you do not qualify.)
 Import diesel
 Produce, refine, manufacture
 Acquire diesel fuel (not previously
or blend diesel fuel
taxed) for distribution in Utah
1b.
Motor Fuel
Effective date (mm/dd/yy): _________
Qualifications:
(Check all operations that apply to you. If none, you do not qualify.)
 Import motor fuel for use,
 Produce, refine, manufacture or
 Purchase motor fuel for resale
 Blend
distribution or sale
compound motor fuel for use,
in wholesale quantities to retail
distribution or sale
dealers inside or outside Utah
(does not require a license if all
Utah tax is paid to a Utah
licensed distributor)
1c.
Aviation Fuel
Effective date (mm/dd/yy): _________
Qualifications:
(Check all operations that apply to you. If none, you do not qualify.)
 Import aviation fuel for use,
 Produce, refine, manufacture or
 Purchase aviation fuel for resale
 Blend
distribution or sale
compound aviation fuel for use,
in wholesale quantities to retail
distribution or sale
dealers inside or outside Utah
 Make aviation fuel retail sales
(does not require a license if all
 to both federally certificated
Utah tax is paid to a Utah
air carriers and other persons
licensed distributor)
1d.
Environmental Assurance Fee
Effective date (mm/dd/yy): _________
Qualifications:
(Check all operations that apply to you. If none, you do not qualify.)
 Import petroleum products for
 Produce, refine, manufacture or compound
use, distribution or sale
petroleum products for use, distribution or sale
1e.
Other Special Fuels
Effective date (mm/dd/yy): _________
(For suppliers of CNG, LNG or hydrogen for highway use. A supplier is an owner or lessor of equipment used to store or disburse
CNG, LNG or hydrogen.)
Qualifications:
(Check all operations that apply to you. If none, you do not qualify.)
 Owner of CNG compression equipment
  Lessor of CNG compression equipment
 Owner of LNG storage/disbursement equipment
 Lessor of LNG storage/disbursement equipment
 Owner of hydrogen storage/disbursement equipment
 Lessor of hydrogen storage/disbursement equipment
1f. Estimate your monthly total taxable gallons for each fuel type you checked.
50,000 or less
50,001-150,000
150,001-300,000
300,001 or more



1. Aviation fuel



2. Environmental assurance fee
* Estimate taxable gallons in



3. Motor fuel
gasoline gallon equivalents



(GGE = 5.66 lbs.)
4. Special fuel
** Estimate taxable gallons in



5. Compressed Natural Gas*
diesel gallon equivalents



6. Liquefied Natural Gas**
(DGE = 6.06 lbs.)



7. Hydrogen***
*** Estimate taxable gallons in
gasoline gallon equivalents
(GGE = 2.198 lbs.)
Section 1 continued on next page
TC-69FUEL
TC-69 Schedule FUEL
Rev. 6/19
Fuel Tax Types
EIN/SSN: __ __ _ __ __ __ _
Fill out the section(s) that apply. Attach this schedule to your TC-69 form to register for any of the following:
• Fuel tax license (motor fuel, special fuel, aviation fuel, hydrogen, environmental assurance fee, CNG, LNG)
• International Fuel Tax Agreement
• Special Fuel User
To apply for IRP, use forms TC-852 and TC-899B.
Clear form
Print Form
Section 1 – Fuel License

1a.
Special Fuel Supplier
Effective date (mm/dd/yy): _________
Qualifications:
(Check all operations that apply to you. If none, you do not qualify.)
 Import diesel
 Produce, refine, manufacture
 Acquire diesel fuel (not previously
or blend diesel fuel
taxed) for distribution in Utah
1b.
Motor Fuel
Effective date (mm/dd/yy): _________
Qualifications:
(Check all operations that apply to you. If none, you do not qualify.)
 Import motor fuel for use,
 Produce, refine, manufacture or
 Purchase motor fuel for resale
 Blend
distribution or sale
compound motor fuel for use,
in wholesale quantities to retail
distribution or sale
dealers inside or outside Utah
(does not require a license if all
Utah tax is paid to a Utah
licensed distributor)
1c.
Aviation Fuel
Effective date (mm/dd/yy): _________
Qualifications:
(Check all operations that apply to you. If none, you do not qualify.)
 Import aviation fuel for use,
 Produce, refine, manufacture or
 Purchase aviation fuel for resale
 Blend
distribution or sale
compound aviation fuel for use,
in wholesale quantities to retail
distribution or sale
dealers inside or outside Utah
 Make aviation fuel retail sales
(does not require a license if all
 to both federally certificated
Utah tax is paid to a Utah
air carriers and other persons
licensed distributor)
1d.
Environmental Assurance Fee
Effective date (mm/dd/yy): _________
Qualifications:
(Check all operations that apply to you. If none, you do not qualify.)
 Import petroleum products for
 Produce, refine, manufacture or compound
use, distribution or sale
petroleum products for use, distribution or sale
1e.
Other Special Fuels
Effective date (mm/dd/yy): _________
(For suppliers of CNG, LNG or hydrogen for highway use. A supplier is an owner or lessor of equipment used to store or disburse
CNG, LNG or hydrogen.)
Qualifications:
(Check all operations that apply to you. If none, you do not qualify.)
 Owner of CNG compression equipment
  Lessor of CNG compression equipment
 Owner of LNG storage/disbursement equipment
 Lessor of LNG storage/disbursement equipment
 Owner of hydrogen storage/disbursement equipment
 Lessor of hydrogen storage/disbursement equipment
1f. Estimate your monthly total taxable gallons for each fuel type you checked.
50,000 or less
50,001-150,000
150,001-300,000
300,001 or more



1. Aviation fuel



2. Environmental assurance fee
* Estimate taxable gallons in



3. Motor fuel
gasoline gallon equivalents



(GGE = 5.66 lbs.)
4. Special fuel
** Estimate taxable gallons in



5. Compressed Natural Gas*
diesel gallon equivalents



6. Liquefied Natural Gas**
(DGE = 6.06 lbs.)



7. Hydrogen***
*** Estimate taxable gallons in
gasoline gallon equivalents
(GGE = 2.198 lbs.)
Section 1 continued on next page
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TC-69FUEL_2
1g. General questions
We may deny your license if you do not answer all questions that apply to you.
1. Provide the state, supplier and estimated monthly gallons of fuel imports (attach additional sheets if necessary):
a. Motor fuels
State importing from: _____
Supplier name: _ __ __ ___ __ _ _ _
Est. gallons per month: _____ ___ _
b. Diesel/biodiesel fuels
State importing from: _____
Supplier name: _ __ __ ___ __ _ _ _
Est. gallons per month: _____ ___ _
c. Aviation fuels
State importing from: _____
Supplier name: _ __ __ ___ __ _ _ _
Est. gallons per month: _____ ___ _
d. Other petroleum
State importing from: _____
Supplier name: _ __ __ ___ __ _ _ _
Est. gallons per month: _____ ___ _
2. How will you report motor, aviation and diesel fuel gallons?
(The basis you choose must stay the same for the calendar year. You may only change your election on January 1.)
 Gross election – actual meter amount
 Net election – converted to 60 degrees
Section 2 – IFTA
Apply for an IFTA license if you have one or more qualified vehicles that travel interstate. A qualified vehicle is a Utah registered vehicle
which includes one of the following configurations:
• Two axles and a gross vehicle weight exceeding 26,000 pounds
• Two axles and a registered weight exceeding 26,000 pounds
• Three or more axles regardless of weight (power unit only)
• A combined vehicle weight exceeding 26,000 pounds (power unit and trailer)
2a. Effective date (mm/dd/yy): __ __ _ __ __
2b. USDOT number: _ ____ __ __ _
2c. IFTA Jurisdictions
List all IFTA jurisdictions in which you will have bulk fuel storage.
2d. IFTA Decals
There is a $4.00 cost per decal set. Calculate the amount due and make a check or money order payable to the Utah
State Tax Commission.
_ _ _ __ _
Number of qualified vehicles needing IFTA decals
Cost per decal set
x
$4.00
_ _ _ __ _
Total due (multiply number of vehicles by $4.00)
$
2e. IFTA Record Statement:
Applicant agrees to comply with reporting, payment, record keeping, and license display requirements as
specified in the International Fuel Tax Agreement. The applicant further agrees that the base jurisdiction may withhold refunds due if
applicant is delinquent on payment of fuel taxes due any member jurisdiction. Failure to comply with these requirements shall be grounds
for revocation of license in all member jurisdictions.
I certify that to the best of my knowledge, the information is true, accurate and complete, and any falsification will subject me to appropriate
civil and/or criminal sanction by the base jurisdiction.
__ __ __ _ __ __ _ __ __ ____
__ ___ ___ ___
Sign here:
Title:
__ __ _ __ _ _ __ __ _ ___ ___
___ ___ ___ __
Print name:
Date:
continued on next page
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TC-69FUEL_3
Section 3 – SFU
Apply for an SFU license if you have qualified vehicles that travel only in Utah, any of which are diesel powered. For the definition of a
qualified vehicle, see Section 2.
Special Fuel Users are not required to file a quarterly return, unless any of the following conditions apply:
• If you have exempt use of Utah tax paid fuel, you may file for a refund on a quarterly basis using form TC-922, IFTA/SFU Tax Return
• If you are anticipating a refund or you have bulk storage, maintain detailed mileage records and summaries, detailed fuel purchase
records and bulk disbursement records for vehicles traveling in Utah
• If you purchase fuel without the proper Utah tax paid, you will be required to file a return, form TC-922, due and payable at the Tax
Commission on or before the last day of the month following the reporting period
• You do not have any qualified vehicles, but do have bulk storage of diesel fuel in Utah AND a diesel powered motor vehicle which
operates on public highways.
3a. Effective date (mm/dd/yy): _ __ __ _ __ _
3b. SFU Decals
_ ____
There is no charge for SFU decals. Enter the number of qualified vehicles needing SFU decals:
3c. SFU Record Statement:
By signing this application, I acknowledge that I will comply with reporting, payment, record keeping and
license display requirements. I agree that Utah may withhold any refunds due if I become delinquent paying fuel or other taxes. Failure to
comply with these provisions are grounds for revocation of my SFU permit. I certify that the information contained herein is true, correct and
complete.
I have read and understand the certification statements above and agree to comply with the requirements for SFU. The information
provided, to the best of my knowledge, is true and correct.
_ __ _ __ __ _ __ __ __ ____ _
_ ____ ___ ___
Sign here:
Title:
__ _ __ __ _ _ _ __ __ _ ___ __
___ ___ ___ __
Print name:
Date:
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