Form A-3711-MF "Motor Fuel Tax Refund Claim" - New Jersey

What Is Form A-3711-MF?

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

Form Details:

  • Released on October 1, 2000;
  • The latest edition provided by the New Jersey Department of the Treasury;
  • 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 A-3711-MF by clicking the link below or browse more documents and templates provided by the New Jersey Department of the Treasury.

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Download Form A-3711-MF "Motor Fuel Tax Refund Claim" - New Jersey

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State of New Jersey
(DO NOT USE)
A-3711-MF (10-00, R9)
DEPARTMENT OF THE TREASURY
Refund No __________________________
DIVISION OF TAXATION
Claim Required by
Title 54, Taxation, Subtitle 6,
MOTOR FUEL TAX
Chapter 39, Revised
Claim Checked by ___________________
REFUND CLAIM
Statutes as Amended
This claim must be postmarked no later than the last business day of the sixth month following the month during which the fuels were
R
R
E
purchased. Send this claim to the DIVISION OF TAXATION, Motor Fuels Tax Section, PO Box 243, Trenton, NJ 08695. This claim
E
A
shall cover all the purchases in that calendar month which you set forth in the space directly below.
A
D
D
DO NOT INCLUDE PURCHASES OF MORE THAN ONE CALENDAR MONTH.
1
USE TYPEWRITER OR PRINT WITH INK
FUELS PURCHASED DURING MONTH OF ___________________ ______ CLAIMANT’S 7 DIGIT CODE NUMBER
Not Transferable
_______________________________________________________________________________________________________________________________
Name
_______________________________________________________________________________________________________________________________
Street & Number or R.F.D.
City or Town
State
Zip Code
hereby certifies that the cost of the fuel and the N.J. Motor Fuels Tax, thereon, for which refund is claimed herewith has been paid.
2
GALLONS
STATEMENT OF PURCHASES AND USES
(Omit Tenths)
(Show all N.J. purchases of Motor Fuel regardless of use and attach invoices in support thereof)
(a) TOTAL number of N.J. gallons purchased this month . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(b) Number of gallons upon which NO REFUND is claimed. (Show gallons used on highways, and other non-refundable
gallons). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(c) Number of gallons upon which REFUND of the NEW JERSEY motor fuel tax is claimed . . . . . . . . . . . . . . . . . . . . . . .
(Attach fully receipted invoices in support thereof.)
(d) The Motor Fuel on which Refund is claimed was used for the following purpose(s):
GALLONS
PURPOSE
(Omit Tenths)
DO NOT USE
The following list includes all refundable uses of Motor Fuel.
Diesel
Gasoline
Insert in the “Gallons” column, opposite the proper use, the number of gallons, used in each.
1. Diesel fuel as used by passenger automobiles and motor vehicles of less than 5,000 pounds gross
weight. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2. Operating autobusses over the highways of this State under the provisions of 48:16-25 of the Title
Public Utilities and pursuant to R.S. 48:4-1 and 48:4-3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3. Operating aircraft . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4. Operating agricultural tractors on private property and/or farm machinery . . . . . . . . . . . . . . . . . . . .
5. Operating highway motor vehicles, such as trucks and automobiles, exclusively on private property
6. Operating stationary machinery, or vehicles or implements not designed for transporting persons or
property on public highways, such as pumps, mixers, cranes, shovels, bulldozers, graders, carriers, fork
lifts and like industrial or construction vehicles, implements or machinery. Also block testing. . . . .
7. Cleaning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
8. Operating fire engines and fire fighting apparatus. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
9. Operating ambulances. Operating emergency vehicles used exclusively by volunteer first-aid or rescue
squads. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
10. Operating vehicles running only on rails or tracks. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
11. Heating and lighting. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
12. Operating motor boats or motor vessels used exclusively for Sea Scout Training by a duly chartered
unit of the Boy Scouts of America. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
13. Exported from the State of New Jersey to another State or country. . . . . . . . . . . . . . . . . . . . . . . . . .
14. Operating watercraft used (a) for oystering or clamming, (b) commercial fishing or (c) the carrying of
fishing parties for hire, or (d) for sightseeing or excursion parties. . . . . . . . . . . . . . . . . . . . . . . . . .
Check which use . . . . (a)
(b)
(c)
(d)
15. Rural free delivery carrier in the dispatch of official business.
1st Test:____________________ gals.______________ Date made:________________________
2nd Test:____________________ gals.______________ Date made:________________________
Average of Tests _____________ gals. X ____________ Trips made this month. ______________
NOTE: (This figure must agree with Line (c) above) . . . . . . . . . . . . . . . . . . . . .
TOTAL
State of New Jersey
(DO NOT USE)
A-3711-MF (10-00, R9)
DEPARTMENT OF THE TREASURY
Refund No __________________________
DIVISION OF TAXATION
Claim Required by
Title 54, Taxation, Subtitle 6,
MOTOR FUEL TAX
Chapter 39, Revised
Claim Checked by ___________________
REFUND CLAIM
Statutes as Amended
This claim must be postmarked no later than the last business day of the sixth month following the month during which the fuels were
R
R
E
purchased. Send this claim to the DIVISION OF TAXATION, Motor Fuels Tax Section, PO Box 243, Trenton, NJ 08695. This claim
E
A
shall cover all the purchases in that calendar month which you set forth in the space directly below.
A
D
D
DO NOT INCLUDE PURCHASES OF MORE THAN ONE CALENDAR MONTH.
1
USE TYPEWRITER OR PRINT WITH INK
FUELS PURCHASED DURING MONTH OF ___________________ ______ CLAIMANT’S 7 DIGIT CODE NUMBER
Not Transferable
_______________________________________________________________________________________________________________________________
Name
_______________________________________________________________________________________________________________________________
Street & Number or R.F.D.
City or Town
State
Zip Code
hereby certifies that the cost of the fuel and the N.J. Motor Fuels Tax, thereon, for which refund is claimed herewith has been paid.
2
GALLONS
STATEMENT OF PURCHASES AND USES
(Omit Tenths)
(Show all N.J. purchases of Motor Fuel regardless of use and attach invoices in support thereof)
(a) TOTAL number of N.J. gallons purchased this month . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(b) Number of gallons upon which NO REFUND is claimed. (Show gallons used on highways, and other non-refundable
gallons). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(c) Number of gallons upon which REFUND of the NEW JERSEY motor fuel tax is claimed . . . . . . . . . . . . . . . . . . . . . . .
(Attach fully receipted invoices in support thereof.)
(d) The Motor Fuel on which Refund is claimed was used for the following purpose(s):
GALLONS
PURPOSE
(Omit Tenths)
DO NOT USE
The following list includes all refundable uses of Motor Fuel.
Diesel
Gasoline
Insert in the “Gallons” column, opposite the proper use, the number of gallons, used in each.
1. Diesel fuel as used by passenger automobiles and motor vehicles of less than 5,000 pounds gross
weight. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2. Operating autobusses over the highways of this State under the provisions of 48:16-25 of the Title
Public Utilities and pursuant to R.S. 48:4-1 and 48:4-3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3. Operating aircraft . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4. Operating agricultural tractors on private property and/or farm machinery . . . . . . . . . . . . . . . . . . . .
5. Operating highway motor vehicles, such as trucks and automobiles, exclusively on private property
6. Operating stationary machinery, or vehicles or implements not designed for transporting persons or
property on public highways, such as pumps, mixers, cranes, shovels, bulldozers, graders, carriers, fork
lifts and like industrial or construction vehicles, implements or machinery. Also block testing. . . . .
7. Cleaning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
8. Operating fire engines and fire fighting apparatus. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
9. Operating ambulances. Operating emergency vehicles used exclusively by volunteer first-aid or rescue
squads. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
10. Operating vehicles running only on rails or tracks. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
11. Heating and lighting. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
12. Operating motor boats or motor vessels used exclusively for Sea Scout Training by a duly chartered
unit of the Boy Scouts of America. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
13. Exported from the State of New Jersey to another State or country. . . . . . . . . . . . . . . . . . . . . . . . . .
14. Operating watercraft used (a) for oystering or clamming, (b) commercial fishing or (c) the carrying of
fishing parties for hire, or (d) for sightseeing or excursion parties. . . . . . . . . . . . . . . . . . . . . . . . . .
Check which use . . . . (a)
(b)
(c)
(d)
15. Rural free delivery carrier in the dispatch of official business.
1st Test:____________________ gals.______________ Date made:________________________
2nd Test:____________________ gals.______________ Date made:________________________
Average of Tests _____________ gals. X ____________ Trips made this month. ______________
NOTE: (This figure must agree with Line (c) above) . . . . . . . . . . . . . . . . . . . . .
TOTAL
A-3711-MF (2-96, R-8)
Page 2
LIST OF PURCHASES
Read Carefully Before Listing Your Invoices
3
List below, in the spaces provided, your total purchases of Motor Fuel for this month from each source of supply. Attach invoices to support all purchases
listed. Invoices must be legible and must show the date of purchase, the name of claimant as the purchaser, the number of gallons purchased, the price
per gallon and the tax thereon. Invoices for the gallonage on which refund is claimed herein must be receipted by the supplier over his full signature, to
show that payment has been made.
NOTE: Incomplete invoices or invoices that show alterations or corrections WILL NOT BE ACCEPTED. Attach and include in purchases listed below
invoices for fuel purchased for use in vehicles on public highways.
Month
Purchased From
Gallons
Month
Purchased From
Gallons
Brought Forward
Carried Forward
Total Gallons Purchased this Month
4
The undersigned hereby declares that the statements contained herein are true and that signature has been affixed with full knowledge that any false
statement subjects the signer and the claimant to the penalties of a misdemeanor in accordance with the provisions of Title 54, Taxation, Subtitle 6, Chapter
39 of the New Jersey Revised Statutes as amended.
________________________________________________________________________________________________________________________
(Signature)
(Title)
IMPORTANT
More claims are returned to the claimant for faulty invoices than for any other reason. Insist that your supplier furnish you with invoices which meet in every
particular the requirements for invoices as outlined in Section 3 above. It will save you inconvenience and expedite the processing of your claim.
AUTOBUS OWNERS ATTENTION
Complete Form A-3710-MF
PROVISIONS OF THE LAW PERTAINING TO REFUNDS
54:39-66
Refund uses, application for refund, supporting tax paid invoices,
(2) who shall have paid the tax for such fuels hereby required to be paid, shall be
distributor procedure.
reimbursed and repaid the amount of tax so paid upon presenting to the
Commissioner an application for such reimbursement or repayment, in form
Any person
prescribed by the Commissioner, which application shall be verified by a declaration
(1) who shall use any fuels as herein defined for any of the following purposes.
of the applicant that the statements contained therein are true. Such application for
(a) [deleted by amendment]
reimbursement or repayment shall be supported by an invoice, or invoices, showing
the name and address of the person from whom purchased, the name of the
(b) autobusses while being operated over the highways of this State in those
purchaser, the date of purchase, the number of gallons purchased, the price paid per
municipalities to which the operator has paid a monthly franchise tax for the use
gallon, and an acknowledgement by the seller that payment of the cost of the fuel,
of the street therein under the provisions of 48:16-25 of the Title Public Utilities
including the tax thereon, has been made. Such invoice, or invoices, shall be legibly
and pursuant to RS 48:4-1 and 48:4-3,
written and shall be void if any corrections or erasures shall appear on the face
(c) agricultural tractors not operated on a public highway,
thereof.
The Commissioner may, in his discretion, permit a distributor entitled to a refund
(d) farm machinery,
under the provisions of this section to take credit therefor, in lieu of such refund, in
(e) aircraft,
such manner as the commissioner may require, on a report filed pursuant to section
54:39-27 of the Revised Statutes.
(f) ambulances,
54:39-67 Payment of refunds, time limit, false statements, fraudulent payments,
(g) rural free delivery carriers in the dispatch of their business,
misdemeanor.
(h) such vehicles as run only on rails or tracks, and such vehicles as run in
Upon approval by the director of such application a warrant shall be drawn upon the
substitution thereof,
State Treasurer for the amount of such claim in favor of such claimant and such warrant
shall be paid from the tax collected on motor fuel. The application for reimbursements
(i) such highway motor vehicles as are operated exclusively on private property,
and repayments shall be filed with the director on or before the last business day of the
(j) motor boats or motor vessels used exclusively for or in the propagation,
sixth month following that in which the fuels in question were purchased. [Any person
planting, preservation and gathering of oysters and clams in the tidal waters of
or the member of any firm or the officer or agent of any corporation who shall make
this State,
false statement in any application required for the reimbursement and repayment of any
taxes, or who shall collect or cause to be repaid to him or to any other person any such
(k) motor boats or motor vessels used exclusively for commercial fishing,
reimbursement or refund without being entitled to the same shall be guilty of a
(l) motor boats or motor vessels while being used for hire for fishing parties or
misdemeanor.
being used for sightseeing or excursion parties,
54:39-68 Establishing claim
(m) cleaning,
In order to establish the validity of claims filed, the claimant shall be required to
(n) fire engines and fire-fighting apparatus,
maintain and preserve for a period of at least two years such fuel consumption records
as may be prescribed by the Commissioner. The Commissioner shall have the right to
(o) stationary machinery and vehicles or implements not designed for the use of
require a claimant to furnish such additional proof of the validity of a claim as the
transporting persons or property on the public highway,
commissioner may determine, and to examine the books and records of the claimant for
(p) heating and lighting devices,
such purpose. Failure of the claimant to maintain and preserve such records, furnish
such additional proof or to accede to the demand for such examination by the
(q) fuels previously taxed under this chapter and later exported or sold for
Commissioner, or any of his representatives, shall constitute a waiver of all rights to the
exportation from the State of New Jersey to any other State or country provided,
claim or claims questioned and such subsequent claims as the commissioner may
proof satisfactory to the Commissioner of such exportations is submitted,
determine.
(r) motor boats or motor vessels used exclusively for Sea Scout Training by a duly
chartered unit of the Boy Scouts of America,
54:39-69 Separate invoices where refund claimed.
When fuel is sold to any person who shall claim to be entitled to a refund of the tax
(s) emergency vehicles used exclusively by volunteer first aid or rescue squads,
hereunder imposed, the seller of such fuel shall furnish the purchaser with an invoice,
(t) diesel fuel as used by passenger automobiles and motor vehicles of less than
or invoices, in conformity with the requirements pertaining to invoices set forth under
5,000 pounds gross weight, and
section 54:39-66 hereof.
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