Form 96-0152 "Use Fuel Vendor Refund Application" - Arizona

What Is Form 96-0152?

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

Form Details:

  • Released on June 1, 2020;
  • The latest edition provided by the Arizona Department of Transportation;
  • 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 96-0152 by clicking the link below or browse more documents and templates provided by the Arizona Department of Transportation.

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Download Form 96-0152 "Use Fuel Vendor Refund Application" - Arizona

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Mail Drop 521M
Fuel Tax Refund Compliance Unit
USE FUEL VENDOR
PO Box 2100
REFUND APPLICATION
Phoenix AZ 85001-2100
602-712-8727
• Complete online or in black ink
Clear
azdot.gov
96-0152 R06/20
• Mail to the address above
Checks are now being mailed directly from the Arizona Department of Administration and we are no longer able to attach a copy of the refund
application to the check. Please keep a copy of your application for your records.
Licensed Vendors have 3 years from date of sale to submit claim; Non-licensed have six months from date of sale to submit claim
Refund Period Beginning Date
Refund Period Ending Date
Federal EIN
Refund Account Number
G –
Company Name
ADOT License Number
Doing Business As (DBA)
Refund Mailing Address
Check if changed City
State
Zip
Contact Person Name
Contact Person Phone
Email
(
)
A use fuel vendor in Arizona is required to be licensed. If you do not have a use fuel vendor license, you must first license your
company online through
http://azdot.gov/mvd/professional-services/FuelTaxInfo/setup-arizona
and then submit this application
with the approval date of your license.
This form must be used to apply for use fuel tax differential on use fuel sold to light class motor vehicles or exempt use class
motor vehicles. Refund on use fuel sold for use in qualifying motor vehicles is at the rate of $.08 per gallon.
All refund applications, with attachments, must be mailed to the address above. The vendor must keep a copy of the refund
application with attachments. The vendor must complete this form in its entirety and any other required forms. The request will
be returned for any missing information. Proper documentation must be kept to verify all claims for refund. If the amount you
claim for refund is later determined to be incorrect, you may be assessed for tax due subject to penalty and interest pursuant to
Arizona law.
Total Gallons Claimed For Refund
Total Gallons
Total Gallons
Adjustment
ADOT Use
Total Refund
Purchased *
Claimed *
Rate
VE
x $0.08
0
from Use Fuel Vendor Summary Detail, form #96-0152A, for multiple branches
*
from Use Fuel Vendor Branch Worksheet, form #96-0152B, for a single branch
*
I certify that the Arizona taxes have been paid on all of the gallons claimed above. The original, unaltered invoices
(and supporting documents) for the gallons claimed will be maintained for three years.
Printed Name
Title
Signature (must be original wet signature)
Date
Must be signed by the licensee or an authorized officer of the business. All other signatures require a notarized power of attorney.
ADOT Use
Reviewer
Approved
Approval Date
Postmark Date
Compliance
 Yes
 No
Comments
Claim Number
Initials
Receipts
Comments
Mail Drop 521M
Fuel Tax Refund Compliance Unit
USE FUEL VENDOR
PO Box 2100
REFUND APPLICATION
Phoenix AZ 85001-2100
602-712-8727
• Complete online or in black ink
Clear
azdot.gov
96-0152 R06/20
• Mail to the address above
Checks are now being mailed directly from the Arizona Department of Administration and we are no longer able to attach a copy of the refund
application to the check. Please keep a copy of your application for your records.
Licensed Vendors have 3 years from date of sale to submit claim; Non-licensed have six months from date of sale to submit claim
Refund Period Beginning Date
Refund Period Ending Date
Federal EIN
Refund Account Number
G –
Company Name
ADOT License Number
Doing Business As (DBA)
Refund Mailing Address
Check if changed City
State
Zip
Contact Person Name
Contact Person Phone
Email
(
)
A use fuel vendor in Arizona is required to be licensed. If you do not have a use fuel vendor license, you must first license your
company online through
http://azdot.gov/mvd/professional-services/FuelTaxInfo/setup-arizona
and then submit this application
with the approval date of your license.
This form must be used to apply for use fuel tax differential on use fuel sold to light class motor vehicles or exempt use class
motor vehicles. Refund on use fuel sold for use in qualifying motor vehicles is at the rate of $.08 per gallon.
All refund applications, with attachments, must be mailed to the address above. The vendor must keep a copy of the refund
application with attachments. The vendor must complete this form in its entirety and any other required forms. The request will
be returned for any missing information. Proper documentation must be kept to verify all claims for refund. If the amount you
claim for refund is later determined to be incorrect, you may be assessed for tax due subject to penalty and interest pursuant to
Arizona law.
Total Gallons Claimed For Refund
Total Gallons
Total Gallons
Adjustment
ADOT Use
Total Refund
Purchased *
Claimed *
Rate
VE
x $0.08
0
from Use Fuel Vendor Summary Detail, form #96-0152A, for multiple branches
*
from Use Fuel Vendor Branch Worksheet, form #96-0152B, for a single branch
*
I certify that the Arizona taxes have been paid on all of the gallons claimed above. The original, unaltered invoices
(and supporting documents) for the gallons claimed will be maintained for three years.
Printed Name
Title
Signature (must be original wet signature)
Date
Must be signed by the licensee or an authorized officer of the business. All other signatures require a notarized power of attorney.
ADOT Use
Reviewer
Approved
Approval Date
Postmark Date
Compliance
 Yes
 No
Comments
Claim Number
Initials
Receipts
Comments