Free TC-114A - Utah

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Utah State Tax Commission

Application For Government Aviation Fuel Tax Refund

AG-RF
TC -114A Rev. 1/01

Telephone: (801) 297-2200 for assistance (1-800-662-4335 outside Salt Lake City but inside Utah)
Name Federal identification or Social Security no.

Street address

Filing period (Begin: mmyy End: mmyy) Begin: End:

City, State, ZIP code

Refund application may not be filed more often than on a quarterly basis.
Invoice number Transaction date Vendor's name and address Airport name Number of GALLONS Aviation fuel tax paid

1. Total gallons (add "Number of Gallons" column) 2. Total Aviation Fuel Tax Paid (add "Aviation fuel tax paid" column). This is your TOTAL REFUND

1 2

I certify that I meet all the conditions to qualify for this refund. I have examined this refund application, including any accompanying schedules, and certify that to the best of my knowledge it is true, correct and complete.
Signed X Date signed Title Telephone

If you need an accommodation under the Americans with Disabilities Act, contact the Tax Commission at (801) 297-3811 (TDD (801) 297-3819). Please allow three working days for a response.

General Information
Utah Code Section 59-13-403 and 59-13-201 allows federal and Utah state and local government entities to file for a refund of Utah fuel taxes paid on aviation fuel purchased in quantities of less than 750 gallons for government use. This refund applies only to aviation fuel purchased for the government's official and exclusive use in government vehicles, aircraft, and equipment. Sale or delivery to individuals or to other businesses operating under government contract, personal use, for retail sale on or off government property or any other distribution to third parties do not qualify for this refund. If you need additional help or information, contact the Utah State Tax Commission at (801) 297-2200 or, if outside the Salt Lake area but within Utah, call 1-800-662-4335. Original records supporting the refund claim must be maintained by the government entity for three years . following the year of refund. To file for a refund, mail or bring this refund form to the Utah State Tax Commission, 210 North 1950 West, Salt Lake City, Utah 84134. Refund claims for aviation fuel taxes paid may be filed within 30 days after the end of any calendar quarter, for taxes accumulated for that calendar quarter.

Instructions For Completing This Form
Enter the full name, address, and Federal Identification Number of the government entity applying for the refund in the space provided. Use this same name and number whenever you file for a refund. You must provide all information requested on this form for each purchase of aviation fuel for which you paid Utah aviation fuel taxes. Attach additional forms if necessary. Please write the airport name from the "Licensed Utah Airports" list below on the front of this schedule under "Airport name."
Beaver Municipal Blanding Municipal San Juan County/Bluff Brigham City Municipal Bryce Canyon Bullfrog Basin Cal Black Memorial Canyonlands Field/Moab Airport Carbon County/Price Airport Cedar City Regional Daggett County/Manila Airport Delta Municipal Duchesne Municipal Dutch John Eagle Mountain/Jake Garn Escalante Municipal Fillmore Municipal Green River Municipal Hanksville Heber Valley/Russ Mcdonald Field Huntington Hurricane Junction Kanab Municipal Logan-Cache Manti-Ephraim Milford Municipal Monticello Morgan County Mount Pleasant Canyonlands Needles Outpost Nephi Municipal Ogden-Hinckley Panguitch Municipal Parowan Provo Municipal Richfield Roosevelt St George Municipal Salina-Gunnison Salt Lake City Airport Number 2 Salt Lake City International Skypark (Woods Cross) Spanish Fork/Springville Tooele Valley-Bolinder Field Tremonton Municipal Vernal/Uintah County Wayne Wonderland (Loa) Tooele County/Wendover Airport Other: For other airports not listed, describe by most commonly used name or closest city or town.