Free DR-309660 - Florida

Florida Department of Revenue Application for Pollutants Tax Refund

DR-309660 R.01/09
Rule 12B-5.150 Florida Administrative Code Effective 04/09

Complete Parts 1 through 6 and attach appropriate documentation. Type or print clearly. Your refund application will be rejected if red boxes are not completed in full.
Part 1 Fill in

Handwritten Example

Typed Example Use black ink.

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Mail application to: Refund Subprocess Florida Department of Revenue PO Box 6490 Tallahassee FL 32314-6490

Name of applicant: Mailing street address: Mailing city, state, ZIP: Location street address: Location city, state, ZIP: Business telephone number (include area code): Fax number (include area code optional):
Part 2 Sign and date this form.

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Home telephone number (include area code): E-mail address (optional):

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

Signature of applicant/representative:

Date:

Print name:

Title:

Important - A Florida Department of Revenue Power of Attorney (Form DR-835) must be properly executed and included if the refund request is submitted by the applicant's representative. Representative's phone number:
Part 3 Enter amount of refund. Part 4 Provide the identification number under which the tax was paid. If you do not have a federal employer identification number, provide your social security number. Part 5 Enter the period shown on the tax return(s) used to report the tax and/or when it was paid. Part 6 Clarify and speed up your refund claim by providing a brief explanation.

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Fuel tax license number: ­

Identification number of applicant: Federal employer identification number: ­ Business partner number:

Period

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M

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D

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Y

to

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M

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D

D

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Y

Y

Paid

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M

D

D

Y

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to

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M

D

D

Y

Y

Reasons for this refund (additional sheets may be added):

FOR DOR USE ONLY

DOC TYPE 76

REFUND Approval Amount $ _________________________________ Date ____________________________________________ Approved by______________________________________ Review Refund Amount $ __________________________________ Date ____________________________________________ Approved by ______________________________________

Florida Department of Revenue Application for Pollutants Tax Refund
Coastal Protection Schedule A. Tax-paid petroleum bunkered in a vessel or exported
1. Beginning Inventory (Must agree with closing inventory from prior quarter) 2. Purchases (From completed Schedule 1 ­ Schedule of Purchases) 3. Ending inventory (Use this figure for beginning inventory on next claim) 4. Barrels consumed ( Add Lines 1 and 2. Subtract Line 3) 5. Barrels not eligible for refund 6. Barrels claimed for refund (Line 4 minus Line 5 ) 7. Refund (Line 6 multiplied by the rate per barrel)

DR-309660 R. 01/09 Page 2

Water Quality

Inland Protection

$

$

$

Schedule B. Tax-paid motor oil and lubricants bunkered in a vessel or exported
8. Beginning Inventory (Must agree with closing inventory from prior quarter) 9. Purchases (From Schedule 1- Schedule of Purchases) 10. Ending inventory (Use this figure for beginning inventory on next claim) 11. Gallons consumed ( Add Lines 8 plus 9. Subtract Line 10) 12. Gallons not eligible for refund 13. Gallons claimed for refund (Line 11 minus Line 12) 14. Refund (Line 13 multiplied by rate per gallon)

$

$

$

Schedule C. Tax-paid pollutant exported from the state by a licensee
15. Beginning Inventory (Must agree with closing inventory from prior quarter) 16. Purchases (From Schedule 1- Schedule of Purchases) 17. Ending inventory (Use this figure for beginning inventory on next claim) 18. Barrels consumed ( Add Lines 15 plus 16. Subtract Line 17) 19. Barrels not eligible for refund 20. Barrels claimed for refund (Line 18 minus Line 19) 21. Refund (Line 20 multiplied by rate per barrel)

$

$

$

Schedule D. Solvents
22. Beginning Inventory (Must agree with closing inventory from prior quarter) 23. Purchases (From Schedule 1-Schedule of Purchases) 24. Ending inventory (Use this figure for beginning inventory on next claim) 25. Gallons consumed ( Add Lines 22 plus 23. Subtract Line 24) 26. Gallons not eligible for refund 27. Gallons claimed for refund (Line 25 minus Line 26) 28. Refund (Line 27 multiplied by rate per gallon) 29. Total net refund requested (Add Lines 7 plus 14 plus 21 and Line 28) 30. Less refund processing fee 31. Net refund due (Line 30 minus Line 31)

$ $ $
$ -2.00

$

$

SCHEDULE 1

Purchase Invoices for Florida Pollutants Taxes Paid
Quarter Ending Lic/FEIN

DR-309660 R. 01/09 Page 3

Attachment Schedule for Pollutants Used in Marine Bunkering Engaged in Interstate or Foreign Commerce and/or Exported Out of Florida

Company Name

Invoice Number Supplier's FEIN Supplier's Address

Purchase Date

Supplier's Name

Type of Pollutant Purchased

Tax-paid Gallons or Barrels Purchased FL Pollutants Tax Paid Water Quality

FL Pollutants Tax Paid Inland Protection

FL Pollutants Tax Paid Coastal Protection

Total Florida Pollutants Tax Paid

TOTAL

SCHEDULE 2

Computation Worksheet for Pollutants Used in Marine Bunkering Engaged in Interstate or Foreign Commerce and/or Pollutants Exported Out of Florida
Quarter Ending Lic/FEIN

Sales Invoices For Proof of Florida Pollutants Taxes Paid

DR-309660 R. 01/09 Page 4

Company Name

Invoice Number Purchaser's Name Point of Destination if Applicable Gallons or Barrels Sold

Delivery Date

Vessel's Name if Applicable (Marine Bunkering Only)

Type of Pollutant

Barrels sold

x = =

=

Florida Water Quality Tax Florida Water Quality Tax Florida Inland Protection Tax

The refund rate for inland protection is: .80 cents per barrel for petroleum products The refund rate for water quality is: .05 cents per barrel for petroleum products and all other pollutants not listed .02 cents a barrel for ammonia .059 cents per gallon for solvents .025 cents per gallon for motor oil and lubricants

Gallons sold

x

Barrels sold

x

TOTAL REFUND $

Important Information Concerning Pollutants Tax Returns

DR-309660 R. 01/09 Page 5

1.

Only persons licensed according to Chapter 206, F.S., can apply for a pollutant tax refund. Refund applicants are entitled to a refund of: A. Tax-paid petroleum products exported from the state or bunkered into marine vessels engaged in interstate or foreign commerce. 1) Refund of 5 cents per barrel levied under section 206.9935(2), F.S., (Tax for Water Quality). 2) Refund of 80 cents per barrel levied under section 206.9935(3), F.S., (Tax for Inland Protection). B. Tax-paid motor oil and lubricants products exported from the state or bunkered into marine vessels engaged in interstate or foreign commerce. 1) Refund of 2.5 cents per gallon levied under section 206.9935(2), F.S., (Tax for Water Quality) for motor oil and lubricants. C. Tax-paid ammonias or products containing ammonia exported from the state. 1) Refund of 2 cents per barrel levied under section 206.9935(2), F.S., (Tax for Water Quality) for ammonia. 2) The timing of the refund claim is based on the date on which the pollutant or the product containing the pollutant was exported and not the date on which the pollutant was originally purchased. D. Tax-paid solvents exported or consumed in the manufacture or production of a product that is not a pollutant or consumed, blended, or mixed to produce a pollutant that is subject to the tax for water quality. 1) Refund of 5.9 cents per gallon levied under section 206.9935(2), F.S., (Tax for Water Quality).

5.

Effective January 1, 2000, 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. The request for refund must be supported by purchase invoices, charge tickets, sales slips, or other tangible evidence that supports the validity of the refund claim. Evidence may include items such as tax-paid invoices, applicable export schedules, and/or shipping and delivery documents. A. Purchase invoices verifying the payment of taxes imposed under Section 206.9935, Florida Statutes, should contain the following information: · Invoice number · The name, mailing address, and location address of the supplier · Type of pollutant and the number of gallons or barrels purchased · Purchase date · The pollutant tax paid per gallon or per barrel · The Department of Environmental Protection storage tank facility identification number for the supplier, if applicable, or supplier's Federal Identification Number (FEIN)

6.

If a taxpayer is remitting pollutants tax via Form DR-904 (Pollutants Tax Return), a copy of the DR-904 must be provided at the time of refund submission. B. Sales invoices should contain the following: · Invoice number · Delivery date · Purchaser's name · Vessel's name (if applicable) · Point of destination (if applicable) · Gallons or barrels sold · Type of pollutant

2.

Applications are to be used only for the quarter indicated on the face of this application. Only original refund applications are acceptable. Application forms may be requested by contacting the Refund Section of the Department of Revenue at (850) 488-8937. Claims must be filed quarterly, no later than the last day of the month immediately following the quarter. The filing date may be extended one additional month only if a justified excuse is submitted in writing with the claim and only if the prior quarter's claim was filed on time. Amended applications for the prior calendar quarter must be received by the Department by the current calendar quarter's deadline. A refund will not be authorized for an amount less than $5 for any given period.
Purchases Made During January, February, and March April, May, and June July, August, and September October, November, and December Claims Must Be Filed By* April 30 July 31 October 31 January 31 With A Written Excuse ­ No Later Than May 31

3.

Instead of original purchase and sales invoices, you may submit schedules provided they include the information required above. 7. First-time users of this form must provide proof of pollutants tax paid by submitting either invoices or Form DR-904. If beginning inventory is being claimed, proof of pollutants tax paid for the beginning inventory must be provided either by invoices or by Form DR-904. In the event of an overpayment of any refund, the Department will refuse to make further refunds and advise the payee of the amount to be reimbursed. A processing fee of $2.00 will be deducted from each claim.

4.

8.

9.
August 31 November 30 February 28

*Amended application for prior quarter must be received by current quarter's deadline. Example: An amended March quarterly application must be submitted by July 31.

10. Any person licensed according to Chapter 206, F.S., who is eligible for a refund according to Section 206.9942, F.S., may, take a credit on the monthly Pollutants Tax Return (Form DR-904), instead of applying for a refund. The credit taken must not exceed the tax imposed on those gallons which would otherwise be eligible for refund. Any request for credit must be supported by a charge ticket, sales slip, invoice, or other tangible evidence of the sale showing the tax was paid to the state or supplier; applicable export schedules; and shipping and delivery documents.

DR-309660 Line-By-Line Instructions

DR-309660 R. 01/09 Page 6

Schedule A -- Tax-paid petroleum products exported from the state or bunkered into a marine vessel engaged in interstate or foreign commerce by a licensed terminal supplier, importer, exporter, producer, wholesaler, or dealer. Line 1. Beginning inventory ­ Must agree with closing inventory from prior quarter. If prior quarters claim was not filed, enter "0". Barrels purchased ­ This represents petroleum products purchased during this calendar quarter. The information provided with Schedule 1 must support these purchases. Ending inventory2 ­ Actual physical inventory as of the last day of this quarter. This will be the beginning inventory for the next quarter. If no refund is due but a closing inventory exists, the claim form must be filed. Total barrels consumed ­ Line 1 plus Line 2 minus Line 3. Barrels not eligible for refund ­ This represents petroleum products which were not exported from the state or bunkered into a marine vessel engaged in interstate or foreign commerce. Barrels claimed for refund ­ This represents petroleum products that were exported from the state or bunkered into a marine vessel engaged in interstate or foreign commerce.

Line 15. Beginning inventory ­ Must agree with closing inventory from prior quarter. If prior quarters claim was not filed, enter "0". Line 16. Barrels purchased1 ­ This represents pollutant products purchased during this calendar quarter. The information provided with Schedule 1 must support these purchases. Line 17. Ending inventory2 ­ Actual physical inventory as of the last day of this quarter. This will be the beginning inventory for the next quarter. If no refund is due but a closing inventory exists, the claim form must be filed. Line 18. Total barrels exported ­ Line 15 plus Line 16 minus Line 17. Line 19. Barrels not eligible for refund ­ This represents pollutants or products containing said pollutants which were not exported from the state. Line 20. Barrels claimed for refund ­ This represents pollutants or products containing said pollutants which were exported from the state. Schedule D -- Tax-paid solvents exported or consumed in the manufacture or production of a product that is not a pollutant or tax-paid solvents which were subsequently consumed, blended, or mixed to produce a pollutant that is subject to tax. Line 22. Beginning inventory ­ Must agree with closing inventory from prior quarter. If prior quarters claim was not filed, enter "0". Line 23. Gallons purchased1 ­ This represents solvents purchased during this calendar quarter. The information provided with Schedule must support these purchases. Line 24. Ending inventory2 ­ Actual physical inventory as of the last day of this quarter. This will be the beginning inventory for the next quarter. If no refund is due but a closing inventory exists, the claim form must be filed. Line 25. Total gallons consumed ­ Line 22 plus Line 23 minus Line 24. Line 26. Gallons not eligible for refund ­ This represents solvents which were not exported or consumed in the manufacture or production of a product that is not a pollutant or solvents which were not subsequently consumed, blended, or mixed to produce a pollutant that is subject to tax. Line 27. Gallons claimed for refund ­ This represents the total solvents which were exported or consumed in the manufacture or production of a product that is not a pollutant or solvents which were subsequently consumed, blended, or mixed to produce a pollutant that is subject to tax.
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Line 2.

Line 3.

Line 4. Line 5.

Line 6.

Schedule B -- Tax-paid motor oil and lubricants products exported from the state or bunkered into a marine vessel engaged in interstate or foreign commerce by a licensed terminal supplier, importer, exporter, producer, wholesaler, or dealer. Line 8. Beginning inventory ­ Must agree with closing inventory from prior quarter. If prior quarters claim was not filed, enter "0". Gallons purchased ­ This represents motor oil and lubricant products purchased during this calendar quarter. The information provided with Schedule 1 must support these purchases.

Line 9.

Line 10. Ending inventory2 ­ Actual physical inventory as of the last day of this quarter. This will be the beginning inventory for the next quarter. If no refund is due but a closing inventory exists, the claim form must be filed. Line 11. Total gallons exported ­ Line 8 plus Line 9 minus Line 10. Line 12. Gallons not eligible for refund ­ This represents motor oil and lubricant products which were not exported from the state or bunkered into a marine vessel engaged in interstate or foreign commerce. Line 13. Gallons claimed for refund ­ This represents motor oil and lubricant products that were exported from the state or bunkered into a marine vessel engaged in interstate or foreign commerce. Schedule C -- Tax-paid pollutants produced in, imported into, or purchased in this state and said pollutants or products containing said pollutants are exported from this state.

To convert solid pesticides and liquid ammonia from pounds to gallons, 10 pounds of solid pesticides equals one gallon and 5.14 pounds of ammonia at 60 degrees Fahrenheit equals one gallon. One barrel is the equivalent of 42 gallons.
2

Pollutant products are considered a part of ending inventory until sold or exported.