Free DR-309639 - Florida

Application for Refund of Tax Paid on Undyed Diesel Used for Off-road or Other Exempt Purposes
Mail to : Florida Department of Revenue Refunds Subprocess PO Box 6490 Tallahassee FL 32314-6490 Fax: 850-410-2526

DR-309639 R. 03/09
Rule 12B-5.150 Florida Administrative Code Effective 04/09

Handwritten Example

Typed Example Use black ink.

0 1

2 3 4 5 6 7 8 9

0123456789

**Your refund application will be rejected if fields in red are not completed in full.
Name of applicant/payee: Mailing street address: Mailing city, state, ZIP: Location street address: Location city, state, ZIP: Sales & Use Tax number: For invoices covering: FEIN: Business telephone number (include area code): ­ ­
Month

2009 through

Month

2009

Fax number (include area code): ­ ­

13. Total Net Refund Requested (From Page 2, Part II, Line 13)

$

,

,
Date

.

Under penalty of perjury, I swear or affirm that this application has been examined by me, is true and correct for the period stated, and is made in good faith according to Chapters 212 and 206, Florida Statutes (F.S.), and the regulations issued under authority thereof.
Signature of Applicant

A properly executed Power of Attorney (DR-835) must be submitted with your Application for Refund if the information in this file is attested to and prepared by a representative. Contact Person

Telephone Number:

­

­

Who May Apply for Refunds?
Any person who purchases undyed, tax-paid diesel fuel for off-road purposes may file a claim for refund. In addition, any person who purchases undyed, tax-paid diesel fuel for on-road purposes OTHER THAN TO PROPEL VEHICLES, may file a claim for refund. However, a person filing such a claim must pay use tax under Section 212.0501, F.S., on the average net cost per gallon. By using this form (DR-309639), taxpayers may take as a credit the fuel tax paid against the use tax due on the gallons consumed by a power take-off unit used to turn a concrete mixer drum, compact solid waste, or unload bulk cargo by pumping. (In computing total use tax due, please include applicable surtax as provided in the list of rates.) Documentation supporting a claim must be kept at the taxpayer's place of business. The Department will pay interest on refunds of this tax if the refund has not been paid or credited within 90 days of receipt of a complete application for refund. A complete application will contain documentation establishing the overpayment. Interest paid by the Department will be computed beginning on the 91st day based upon a statutory floating interest rate that may not exceed 11%. Interest rates are updated January 1 and July 1 of each year. Online Refund Status Inquiry http://www.myflorida.com/dor/eservices/other/refunds/status/ For help in completing this form, please contact: Florida Department of Revenue Refund Subprocess 850-488-8937

DR-309639 R. 03/09 Page 2
Name FEIN

Category:

Please Check All Applicable Boxes: Note: This application can be used for more than one category of refund.

A B C

Fuel used to turn a concrete mixer drum or to compact solid waste. Fuel used for unloading bulk cargo by pumping. Fuel used to propel off-road diesel equipment.

D

Fuel used in off-road stationary equipment or for commercial cooking and heating. (The eligible equipment must have a separate fuel supply system other than the one that propels the vehicle.) 1. 2. 3. 4. gals. gals. gals. gals.

Part I:
1) Beginning Inventory (Measured on the first day of the refund period) 2) Gallons Purchased (From completed Schedule 1A-Schedule of Purchases) 3) Ending Inventory (Measured on the last day of the refund period) 4) Gallons to be Accounted for (Lines 1 plus 2 minus 3) 5) Gallons Consumed in Trucks (For A and B users only) a. Concrete Mixers/Solid Waste Compactors b. Unloading By Pumping c. To Propel Off-road Equipment d. Off-road Stationary Equipment 6c. 6d. 5a. 5b. gals. gals. gals. gals. 7. gals.

6) Gallons Consumed for Other Exempt Off-road Purposes (for C and D users only)

7) Gallons Consumed for Highway Use (Line 4 minus Lines 5a, 5b, 6c, and 6d)

Part II:

Calculation of Refund Due Based on Categories Above:
8) Gallons Eligible for Refund (35% of Part 1, Line 5a) 9) Line 8 multiplied by Average Cost per Gallon (From Schedule 1B, see instructions) 10) Fuel Tax Eligible for Refund (Line 8 multiplied by $ .298) 12) Net Refund Due (Line 10 minus Line 11) 8. 9. 10. 12. 8. 10. 12. 8. $ $ $ $ gals. $ $ $ $ $ 10. 12. 8. 10. 12. 13. $ $ $ gals. $ $ $ $ gals. gals.

A. Refund on Undyed Diesel Fuel Consumed by Concrete Mixers/Solid Waste Compactors:

11) Sales Tax Due [Line 9 multiplied by (6% plus applicable surtax ­ see Schedule 1C)] 11. B. Refund on Undyed Diesel Fuel Consumed For Unloading Bulk Cargo by Pumping: 8) Gallons Eligible for Refund [Part I, Line 5b] 10) Fuel Tax Eligible for Refund (Line 8 multiplied by $ .298) 12) Net Refund Due (Line 10 minus Line 11) C. Refund on Undyed Diesel Fuel Used to Propel Off-Road Equipment: 8) Gallons Eligible for Refund [Part I, Line 6c] 10) Fuel Tax Eligible for Refund (Line 8 multiplied by $ .298) 12) Net Refund Due (Line 10 minus Line 11) 8) Gallons Eligible for Refund [Part I, Line 6d] 10) Fuel Tax Eligible for Refund (Line 8 multiplied by $ .298) 12) Net Refund Due (Line 10 minus Line 11) Total Net Refund Requested (Sum of applicable Line 12 totals 13) for Sections A, B, C, D. Carry forward to Page 1, Line 13) Note: Total gallons eligible for refund cannot exceed Part I, Line 4 (Gallons to be Accounted for). 9) Line 8 multiplied by the Average Cost per Gallon (From Schedule 1B, see instructions) 9. 11) Sales Tax Due [Line 9 multiplied by (6% plus applicable surtax ­ see Schedule 1C)] 11. 9) Line 8 multiplied by the Average Cost per Gallon (From Schedule 1B, see instructions) 9. 11) Sales Tax Due [Line 9 multiplied by (6% plus applicable surtax ­ see Schedule 1C) 11.

D. Refund on Undyed Diesel Fuel Used in Off-road Stationary Equipment or for Commercial Cooking and Heating: 9) Line 8 multiplied by the Average Cost per Gallon (From Schedule 1B, see instructions) 9. 11) Sales Tax Due [Line 9 multiplied by (6% plus applicable surtax ­ see Schedule 1C)] 11.

DR-309639 R. 03/09 Page 3

Schedule 1A
Applicant Name

Schedule of Purchases of Tax-paid Undyed Diesel Fuel
FEIN Invoiced Through Date

This schedule must be complete and returned with application for refund.

Name of Supplier

(1)

Supplier FEIN/DEP Number

(2)

Date Received

(3)

Invoice Number

(4)

Gallons Invoiced

(5)

Invoiced Price Including Tax

(6)

TOTALS

Schedule 1B
1. 2. 3.

Average Cost per Gallon Computation
$ $ $

Total State and Local Option Fuel Tax Paid on Fuel Purchases: (Total of Column 5 from Schedule 1A multiplied by $.298) Total Cost of Purchased Fuel Less State and Local Option Tax: (Total of Column 6 from Schedule 1A minus Line 1 from Schedule 1B) Average Cost per Gallon: (Total of Line 2 from Schedule 1B divided by Column 5 from Schedule 1A), carried out four decimal places

DR-309639 R. 03/09 Page 4

Computation of Sales Tax Due by County Schedule 1C
License No.:__________________________________________________ Period: ____/____/____ to ____/____/____

Name: ___________________________________________________________________________________________ Category: A B
GALLONS SUBJECT TO SALES TAX
GALLONS DUE X

C

D

(Choose one. Use a separate schedule for each applicable category. See Page 2 for explanation of categories.)
RATE SALES TAX DUE
= SALES TAX

COUNTY

*ACPG FROM SCHEDULE 1B
ACPG X

COUNTY

GALLONS SUBJECT TO SALES TAX
GALLONS DUE X

*ACPG FROM SCHEDULE 1B
ACPG X

CODE

RATE

CODE

RATE
RATE =

SALES TAX DUE
SALES TAX

11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44

ALACHUA BAKER BAY BRADFORD BREVARD BROWARD CALHOUN CHARLOTTE CITRUS CLAY COLLIER COLUMBIA DADE (MIAMI-DADE) DESOTO DIXIE DUVAL ESCAMBIA FLAGLER FRANKLIN GADSDEN GILCHRIST GLADES GULF HAMILTON HARDEE HENDRY HERNANDO HIGHLANDS HILLSBOROUGH HOLMES INDIAN RIVER JACKSON JEFFERSON LAFAYETTE

0.0675 0.07 0.065 0.07 0.06 0.06 0.075 0.07 0.06 0.07 0.06 0.07 0.07 0.07 0.07 0.07 0.075 0.07 0.07 0.075 0.07 0.07 0.07 0.07 0.07 0.07 0.065 0.07 0.07 0.07 0.07 0.075 0.07 0.07

45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77

lAKE lEE lEON LEVY LIBERTY MADISON MANATEE MARION MARTIN MONROE NASSAU OKALOOSA OKEECHOBEE ORANGE OSCEOLA PALM BEACH PASCO PINELLAS POlK PUTNAM ST. JOHNS ST. LUCIE SANTA ROSA SARASOTA SEMINOLE SUMTER SUWANNEE TAYLOR UNION VOLUSIA WAKULLA WALTON WASHINGTON TOTAl

0.07 0.06 0.075 0.07 0.07 0.075 0.065 0.065 0.065 0.075 0.07 0.06 0.07 0.065 0.07 0.065 0.07 0.07 0.07 0.07 0.06 0.065 0.065 0.07 0.07 0.07 0.07 0.07 0.07 0.065 0.07 0.07 0.07

*AVERAGE COST PER GALLON

DR-309639 R. 03/09 Page 5

Discretionary Sales Surtax Rates for 2009 (as of November 4, 2008)
COUNTY TOTAL SURTAX RATE EFFECTIVE EXPIRATION DATE DATE COUNTY TOTAL SURTAX RATE EFFECTIVE EXPIRATION DATE DATE

1% Jun 1, 1988 None 1% Sep 1, 1991 None 1% Jan 1, 1988 Dec 2017 None 1.5% (1%) Dec 1, 1989 Dec 2019 (.5%) Jan 1, 2003 Dec 2012 Levy 1% Oct 1, 1992 None Liberty 1% Nov 1, 1992 None Madison 1.5% (1%) Aug 1, 1989 None (.5%) Jan 1, 2007 None Manatee .5% Jan 1, 2003 Dec 2017 Marion .5% Jan 1, 2005 Dec 2009 Martin .5% Jan 1, 2007 Dec 2011 Miami-Dade 1% (.5%) Jan 1, 1992 None (.5%) Jan 1, 2003 None Monroe 1.5% (1%) Nov 1, 1989 Dec 2018 (.5%) Jan 1, 1996 Dec 2015 Nassau 1% Mar 1, 1996 None Okaloosa None Okeechobee 1% Oct 1, 1995 None Orange .5% Jan 1, 2003 Dec 2015 Osceola 1% Sep 1, 1990 Aug 2025 Palm Bch .5% Jan 1, 2005 Dec 2010 Pasco 1% Jan 1, 2005 Dec 2014 Pinellas 1% Feb 1, 1990 Dec 2019 Polk 1% (.5%) Jan 1, 2004 Dec 2018 (.5%) Jan 1, 2005 Dec 2019 Putnam 1% Jan 1, 2003 Dec 2017 St. Johns None St. Lucie .5% Jul 1, 1996 Dec 2026 Santa Rosa .5% Oct 1, 1998 Dec 2018 Sarasota 1% Sep 1, 1989 Dec 2024 Seminole 1% Jan 1, 2002 Dec 2011 Sumter 1% Jan 1, 1993 None Suwannee 1% Jan 1, 1988 None Taylor 1% Aug 1, 1989 Dec 2029 Union 1% Feb 1, 1993 None Volusia .5% Jan 1, 2002 Dec 2016 Wakulla 1% Jan 1, 1988 Dec 2017 Walton 1% Feb 1, 1995 None Washington 1% Nov 1, 1993 None Each county that has a new surtax levy or extension is indicated in bold. Any county that has a surtax that expires in 2009 is also in bold and has an beside the expiration date. Alachua .75% (.5%) Jan 1, 2009 Dec 2010 (.25%) Jan 1, 2005 Dec 2011 Baker 1% Jan 1, 1994 None Bay None Bradford 1% Mar 1, 1993 None Brevard None Broward None Calhoun 1.5% (1%) Jan 1, 2009 None (.5%) Jan 1, 2009 Dec 2018 Charlotte 1% Jan 1, 2009 Dec 2014 Citrus None Clay 1% Feb 1, 1990 Dec 2019 Collier None Columbia 1% Aug 1, 1994 None Dade See Miami-Dade for rates. De Soto 1% Jan 1, 1988 None Dixie 1% Apr 1, 1990 Dec 2029 Duval 1% (.5%) Jan 1, 1989 None (.5%) Jan 1, 2001 Dec 2030 Escambia 1.5% (1%) Jun 1, 1992 Dec 2017 (.5%) Jan 1, 1998 Dec 2017 Flagler 1% (.5%) Jan 1, 2003 Dec 2012 (.5%) Jan 1, 2003 Dec 2012 Franklin 1% Jan 1, 2008 None Gadsden 1.5% (1%) Jan 1, 1996 None (.5%) Jan 1, 2009 Dec 2038 Gilchrist 1% Oct 1, 1992 None Glades 1% Feb 1, 1992 Dec 2021 Gulf 1% (.5%) Jul 1, 1997 Jun 2017 (.5%) Jan 1, 2006 None Hamilton 1% Jul 1, 1990 Dec 2019 Hardee 1% Jan 1, 1998 None Hendry 1% Jan 1, 1988 None Hernando .5% Jan 1, 2005 Dec 2014 Highlands 1% Nov 1, 1989 Oct 2019 Hillsborough 1% (.5%) Dec 1, 1996 Nov 2026 (.5%) Oct 1, 2001 None Holmes 1% Oct 1, 1995 Dec 2013 Indian River 1% Jun 1, 1989 Dec 2019 Jackson 1.5% (1%) Jun 1, 1995 May 2010 (.5%) Jul 1, 1996 Dec 2015

Jefferson Lafayette Lake lee Leon

Instructions for Completing Application for Refund of Tax Paid on Undyed Diesel Fuel Used for Off-road or Other Tax-exempt Purposes Instructions for Page 2 A Power of Attorney, Florida Department of Revenue form DR-835, must be properly executed and included if prepared by your representative. Category:

DR-309639 R. 03/09 Page 6

Check the appropriate boxes based on use of diesel fuel. If the fuel is used for more than one purpose, please check all boxes that apply.

Part I:
Line 1: Beginning Inventory ­ Enter the physical inventory of gallons measured on the first day of the refund period before you include any purchases. Your beginning inventory will be the same as your ending inventory from the previous filing period. Gallons Purchased ­ Enter the number of diesel fuel gallons purchased during the refund period stated on Page 2, Part I, Line 2 of this Application for Refund. Schedule 1A of this application should be used for purchases made in 2009. Ending Inventory ­ Enter the physical inventory of gallons measured on the last day of the refund period. Gallons to be Accounted For ­ Add Line 1 plus Line 2. Subtract Line 3 from the result and enter here. Gallons Consumed in Trucks ­ 5(a) ­ Enter the gallons used to turn concrete mixer drums or to compact solid waste. 5(b) ­ Enter the gallons used to unload bulk cargo by pumping. Gallons Consumed for Other Exempt Off-road Purposes ­ 6(c) ­ Enter the gallons used to propel off-road diesel equipment (e.g., road scrapers, bulldozers and tractors that are NOT used exclusively for agricultural purposes). 6(d) ­ Enter the gallons used in off-road stationary equipment or for commercial cooking and heating (e.g., refrigerated units, generators, pumps, and boilers for commercial establishments). Gallons Consumed for Highway Use ­ Enter the amount on Line 4 (Gallons to be Accounted For) minus the total of Lines 5(a) and 5(b) (gallons consumed in trucks) minus the total of Lines 6(a) and 6(b) (gallons consumed for other purposes).

Line 2:

Line 3: Line 4: Line 5:

Line 6:

Line 7:

Part II:
The gallons eligible for a refund are subject to use tax under section 212.0501, Florida Statutes based on the average cost per gallon. The average cost per gallon is calculated on the cost of the fuel less the state and local option taxes (i.e., $.298 per gallon.) A. A refund will be granted on 35% of the diesel fuel gallons consumed by vehicles using the fuel to turn concrete mixer drums or to compact solid waste as follows: Gallons Eligible for Refund = .35 multiplied by Line 5(a) from Part I Sales Tax Due = (.06 plus surtax) multiplied by (Average Cost per Gallon from Schedule 1B) multiplied by eligible gallons* Net Refund Due = Tax on Eligible Gallons minus Sales Tax Due B. A refund will be granted for undyed diesel fuel used by a power take-off unit or engine exhaust for unloading bulk cargo by pumping. You must provide documentation to verify the actual gallons used to unload bulk cargo by pumping. Gallons Eligible for Refund = Part I, Line 5(b) Sales Tax Due = (.06 plus surtax) multiplied by (Average Cost per Gallon From Schedule 1B) multiplied by eligible gallons* Net Refund Due = Tax on Eligible Gallons minus Sales Tax Due

DR-309639 R. 03/09 Page 7

C. A refund will be granted for on-road taxes paid on gallons of undyed diesel fuel used to propel off-road equipment such as road scrapers, bulldozers, and tractors (when not used exclusively for agricultural purposes) as follows: Gallons Eligible for Refund = Part I, Line 6(c) Sales Tax Due = (.06 plus surtax) multiplied by (Average Cost per Gallon from Schedule 1B) multiplied by eligible gallons* Net Refund Due = Tax on Eligible Gallons minus Sales Tax Due D. A refund will be granted for on-road taxes paid on gallons of undyed diesel fuel used in off-road stationary equipment or for commercial cooking and heating as follows: Gallons Eligible for Refund = Part I, Line 6(d) Sales Tax Due = (.06 plus surtax) multiplied by (Average Cost per Gallon from Schedule 1B) multiplied by eligible gallons* Net Refund Due = Tax on Eligible Gallons minus Sales Tax Due *Since the refund of fuel tax is offset against the liability of sales and use tax, DO NOT report sales and use tax for these same gallons on the Sales Tax Return (DR-15) you file. First time filers must submit the following documentation for the refund to be considered complete: 1. 2. 3. 4. Copy of tax paid invoices or fuel management reports. Explanation of how fuel was used. Equipment list. Power of Attorney form (DR-835), if applicable.

Schedule of Purchases of Tax-Paid Undyed Diesel Fuel (Schedule 1A)
The Schedule of Purchases provides detail to support fuel purchases. If you do not provide all information required under Columns 1 through 6 of this schedule, your refund will be reduced or denied. If you need additional copies of schedules, photocopy as many copies as you need to provide the required information. A fuel management report may substitute for the Schedule of Purchases (1A). However, the fuel management report must be in the same format and provide the same information as required on the Schedule of Purchases (1A), except for Column 2. When reporting less than .50 gallons, round down to the nearest whole gallon. If reporting .50 gallons or greater, round up to the nearest whole gallon.

Computation Schedule of Sales Tax Due by County (Schedule 1C)
If undyed diesel gallons listed on 5a through 6d are used in counties other than your registered county or the county the business is located in, please complete a Schedule C for each refund category reflected on Page 2, Part II.

Online Refund Status Inquiry
You can view the current status of a refund application by accessing the Department's Internet site at http://www.myflorida.com/dor/eservices/other/refunds/status/