Form 72A053-A "Application for Refund of Kentucky Motor Fuel Tax Paid on Nonhighway Motor Fuels" - Kentucky

What Is Form 72A053-A?

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

Form Details:

  • Released on July 1, 2007;
  • The latest edition provided by the Kentucky Department of Revenue;
  • 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 printable version of Form 72A053-A by clicking the link below or browse more documents and templates provided by the Kentucky Department of Revenue.

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Download Form 72A053-A "Application for Refund of Kentucky Motor Fuel Tax Paid on Nonhighway Motor Fuels" - Kentucky

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FOR DEPARTMENT USE ONLY
APPLICATION FOR REFUND
72A053-A (7-07)
Date
Commonwealth of Kentucky
OF KENTUCKY MOTOR FUEL TAX PAID
Processed ______________ By
/
/
_______________
DEPARTMENT OF REVENUE
ON NONHIGHWAY MOTOR FUELS
(KRS 138.344 through 138.355)
➤ ➤ ➤ ➤ ➤ See Instructions on Reverse
Name of
Kentucky Motor Fuels Tax
Applicant ________________________________________________
Refund Permit Number __________________________
Mailing
Federal Employer
Address __________________________________________________
__ __ –__ __ __ __ __ __ __
ID Number
_________________________________________________________
Refund claim is being filed:
City
State
ZIP Code
For calendar quarter ending ____________________
(
)
Telephone Number ________________________________________
For calendar year ending December 31, _____
Agricultural
Special
PART I—Computation of Refund Gallonage
Gasoline
Fuels
1. Kentucky tax-paid motor fuel gallons reflected on attached refund invoices ......................
gal.
gal.
2. Number of line 1 gallons used in unlicensed vehicles on the highways ...............................
gal.
gal.
3. a. Number of gallons of gasoline used in stationary engines or tractors
for agricultural purposes (line 1 minus line 2) .......................................................................
gal.
b. Number of gallons of special fuels used in unlicensed vehicles or
equipment for nonhighway purposes (line 1 minus line 2) .................................................
gal.
PART II—Computation of Kentucky Sales Tax to be Deducted from Special Fuels Tax Refund
Kentucky Sales Tax Permit Number _______________
NOTE: If you claim that the special fuel reported on line 3 above is exempt from the 6 percent Kentucky
sales tax, indicate the reason below and do not complete the remainder of Part II. Proceed to Part III.
I hold an Energy Direct Pay Authorization.
Fuel used for agricultural purposes pursuant to KRS 139.480.
Other (describe) ________________________________________________________________________
______________________________________________________________________________________
4. Total purchase price (including all taxes paid) of all refund special fuels reflected on attached refund invoices ........
$
5. Deductions:
a. Purchase price (including all taxes you paid) of gallons reported on line 2 above .........................................................
$
b. Kentucky special fuels tax paid on gallons reported on line 3 above (Kentucky tax rate (.____) times gallons) ......
$
c. Kentucky Petroleum Environmental Assurance Fee paid on gallons reported on line 3 above
(.014 times gallons) ......................................................................................................................................................................
$
d. Total deduction (add lines 5a, 5b and 5c) ................................................................................................................................
$
6. Amount subject to Kentucky sales tax (line 4 minus line 5d) ..................................................................................................
$
7. Kentucky sales tax rate ...................................................................................................................................................................
.06
8. Total Kentucky sales tax due (to be deducted from refund) (line 6 times line 7) .................................................................
$
PART III—Motor Fuels Refund Computation
9. Total gallons subject to Kentucky motor fuels tax refund (same as line 3 above) ..................
gal.
gal.
10. Gross motor fuels tax refund claimed (line 9 times Tax Rate) ....................................................
$
$
11. Sales tax liability (same as line 8 above) .........................................................................................
$ (
)
12. Net motor fuels tax refund claimed (line 10 minus line 11) ........................................................
$
$
PART IV—Petroleum Environmental Assurance Fee Refund Computation
13. Total gallons subject to Petroleum Environmental Assurance Fee
(same as line 9 above) ........................................................................................................................
gal.
gal.
14. Fee refund claimed (line 13 gallons times .014) .............................................................................
$
$
Kentucky Department of Revenue
IMPORTANT NOTICE ➤ ➤ ➤ ➤ ➤ Mail completed application to:
Motor Fuels Tax Compliance Section
P.O. Box 1303, Station 63
Frankfort, KY 40602-1303
I hereby certify that this requested refund of Kentucky motor fuels tax is supported by correct and unaltered refund invoices issued by a
licensed motor fuels dealer for motor fuel purchases, that the motor fuel for which refund is claimed herein was placed in a tank marked
"Refund Motor Fuel," and that all information contained herein is true to the best of my knowledge and belief. I further certify that none of
the fuel for which refund is claimed was or will be used in licensed vehicles on public highways.
______________________________________________________________
Date ______________________________________ , 20 ______
Signature of Refund Permit Holder or Authorized Representative
FOR DEPARTMENT USE ONLY
APPLICATION FOR REFUND
72A053-A (7-07)
Date
Commonwealth of Kentucky
OF KENTUCKY MOTOR FUEL TAX PAID
Processed ______________ By
/
/
_______________
DEPARTMENT OF REVENUE
ON NONHIGHWAY MOTOR FUELS
(KRS 138.344 through 138.355)
➤ ➤ ➤ ➤ ➤ See Instructions on Reverse
Name of
Kentucky Motor Fuels Tax
Applicant ________________________________________________
Refund Permit Number __________________________
Mailing
Federal Employer
Address __________________________________________________
__ __ –__ __ __ __ __ __ __
ID Number
_________________________________________________________
Refund claim is being filed:
City
State
ZIP Code
For calendar quarter ending ____________________
(
)
Telephone Number ________________________________________
For calendar year ending December 31, _____
Agricultural
Special
PART I—Computation of Refund Gallonage
Gasoline
Fuels
1. Kentucky tax-paid motor fuel gallons reflected on attached refund invoices ......................
gal.
gal.
2. Number of line 1 gallons used in unlicensed vehicles on the highways ...............................
gal.
gal.
3. a. Number of gallons of gasoline used in stationary engines or tractors
for agricultural purposes (line 1 minus line 2) .......................................................................
gal.
b. Number of gallons of special fuels used in unlicensed vehicles or
equipment for nonhighway purposes (line 1 minus line 2) .................................................
gal.
PART II—Computation of Kentucky Sales Tax to be Deducted from Special Fuels Tax Refund
Kentucky Sales Tax Permit Number _______________
NOTE: If you claim that the special fuel reported on line 3 above is exempt from the 6 percent Kentucky
sales tax, indicate the reason below and do not complete the remainder of Part II. Proceed to Part III.
I hold an Energy Direct Pay Authorization.
Fuel used for agricultural purposes pursuant to KRS 139.480.
Other (describe) ________________________________________________________________________
______________________________________________________________________________________
4. Total purchase price (including all taxes paid) of all refund special fuels reflected on attached refund invoices ........
$
5. Deductions:
a. Purchase price (including all taxes you paid) of gallons reported on line 2 above .........................................................
$
b. Kentucky special fuels tax paid on gallons reported on line 3 above (Kentucky tax rate (.____) times gallons) ......
$
c. Kentucky Petroleum Environmental Assurance Fee paid on gallons reported on line 3 above
(.014 times gallons) ......................................................................................................................................................................
$
d. Total deduction (add lines 5a, 5b and 5c) ................................................................................................................................
$
6. Amount subject to Kentucky sales tax (line 4 minus line 5d) ..................................................................................................
$
7. Kentucky sales tax rate ...................................................................................................................................................................
.06
8. Total Kentucky sales tax due (to be deducted from refund) (line 6 times line 7) .................................................................
$
PART III—Motor Fuels Refund Computation
9. Total gallons subject to Kentucky motor fuels tax refund (same as line 3 above) ..................
gal.
gal.
10. Gross motor fuels tax refund claimed (line 9 times Tax Rate) ....................................................
$
$
11. Sales tax liability (same as line 8 above) .........................................................................................
$ (
)
12. Net motor fuels tax refund claimed (line 10 minus line 11) ........................................................
$
$
PART IV—Petroleum Environmental Assurance Fee Refund Computation
13. Total gallons subject to Petroleum Environmental Assurance Fee
(same as line 9 above) ........................................................................................................................
gal.
gal.
14. Fee refund claimed (line 13 gallons times .014) .............................................................................
$
$
Kentucky Department of Revenue
IMPORTANT NOTICE ➤ ➤ ➤ ➤ ➤ Mail completed application to:
Motor Fuels Tax Compliance Section
P.O. Box 1303, Station 63
Frankfort, KY 40602-1303
I hereby certify that this requested refund of Kentucky motor fuels tax is supported by correct and unaltered refund invoices issued by a
licensed motor fuels dealer for motor fuel purchases, that the motor fuel for which refund is claimed herein was placed in a tank marked
"Refund Motor Fuel," and that all information contained herein is true to the best of my knowledge and belief. I further certify that none of
the fuel for which refund is claimed was or will be used in licensed vehicles on public highways.
______________________________________________________________
Date ______________________________________ , 20 ______
Signature of Refund Permit Holder or Authorized Representative
INSTRUCTIONS
This application shall be filed by Kentucky motor fuels tax refund permit holders on a calendar quarter
or calendar year basis. Attach the original invoices issued by the licensed special fuels or gasoline
dealer to this application. These invoices must reflect the itemized tax and fees charged. Use this form
to apply for a refund of the Motor Fuels Tax and Petroleum Environmental Assurance Fee. A separate
check will be issued for the fee refund.
IMPORTANT INFORMATION
• Purchases made prior to the effective date of the Kentucky motor fuels tax refund permit are not
refundable.
• Purchases from retail filling stations do not qualify for refund.
CONTACT THE FOLLOWING
For Forms, Information and Assistance ➤ ➤ ➤ ➤ ➤ Motor Fuels Tax Compliance Section
(502) 564-3853
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