The Utah TC-116 form is an official application used by individuals and entities seeking a refund for fuel taxes paid in the state of Utah. This form is essential for those who have purchased tax-paid gallons of motor fuel, undyed diesel, aviation fuel, or other specific categories and wish to reclaim those taxes under certain conditions. Understanding how to accurately complete this form is crucial for ensuring a smooth refund process.
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The Utah TC-116 form is a crucial document for individuals and entities seeking a refund on fuel taxes paid in the state. This form caters to a variety of applicants, including government entities, non-profit agricultural organizations, and members of the Ute Indian Tribe. It allows these groups to claim refunds for tax-paid gallons of motor fuel, undyed diesel, aviation fuel, and compressed natural gas. The form breaks down the types of fuel and the specific circumstances under which refunds can be claimed, such as fuel lost due to accidents or exported from Utah. Additionally, it includes sections for calculating the Utah Environmental Assurance Fee and provides guidelines for reporting gallons delivered to the Navajo Nation. By detailing the tax rates applicable to different fuel types, the TC-116 ensures that applicants can accurately calculate their potential refunds. Completing this form accurately is essential for receiving the funds owed, making it a vital resource for eligible taxpayers in Utah.
11601
9998
Utah State Tax Commission
Utah Application for
Fuel Tax Refund
TC-116
Rev. 9/10
Name
Mark “X” if this is
a new address:
Address
_____
Physical
address
City
State
ZIP code
Mailing
Foreign country (if not U.S.)
Telephone number
Utah Excise Tax
A - Motor fuel
B - Undyed diesel
1.Utah tax-paid gallons purchased by government entities (from Schedule type 1A)
2.Utah tax-paid gallons exported from Utah (from Schedule type 1B)
3.Utah tax-paid gallons purchased by Ute Indian Tribe (from Schedule type 1C)
FEIN/SSN
_____ Mark "X" if this is a SSN
Tax period (mmddyyyy)
From
To
C - Aviation fuel
D - CNG
4.Utah tax-paid gallons purchased by non-profit agricultural entities (from Schedule type 1D)
5.Total eligible gallons of fuel lost or destroyed by
fire, flood, crime & accident (from Schedule type 1E)
6.Total eligible gallons for each single transaction of 4,500 or more discharged in bankruptcy (from Schedule type 1F)
7.Gallons returned to refinery for re-refining (from Schedule type 1G)
8.Total tax-paid gallons (add lines 1 through 7)
9.Total tax-paid gallons of aviation fuel at 2.5 cents (from Schedule1H)
10.Tax per gallons of aviation fuel at 2.5 cents
(multiply line 9 column C by .025)
11.Total tax-paid gallons of aviation fuel at 4 cents (from Shedule 1I)
12.Tax per gallons of aviation fuel at 4 cents (multiply line 11 column C by .04)
13.Total tax-paid gallons of aviation fuel at 9 cents (from Schedule 1J)
14.Tax per gallons of aviation fuel at 9 cents (multiply line 13 column C by .09)
15.Tax rates
16.Calculated tax-paid (multiply line 8 by line 15 from columns A, B, and D; and add lines 10, 12, and 14 for column C)
00
.245
.085
11602
17. Total Utah exise tax (add line 16, columns A, B, C, and D)
17
Utah Environmental Assurance Fee
18. Utah Environmental Assurance Fee paid gallons
18
exported from Utah (from Schedule type 2A)
19. Utah Environmental Assurance Fee paid gallons placed
19
in nonparticipating tanks (from Schedule type 2B)
20. Utah Environmental Assurance Fee paid gallons for
20
repackaged oil (from Schedule type 2C)
21
21. Total Utah Environmental Assurance Fee paid gallons (add lines 18 through 20)
22.005
22. Tax rate
23
23. Calculated Environmental Assurance Fee (multiply line 21 by line 22)
B - Undyed diesel fuel
65
160
Navajo Nation Refund
24. Total taxable gallons reported to the Navajo Nation
24
25. Gallons delivered to non-Utah portion of Navajo Nation
25
26. Total gallons subject to Utah fuel tax
26
(subtract line 25 from line 24)
27. Navajo 0.5% credit, if taken on Navajo Distributor
27
Tax Return (multiply line 26 by .005)
28. Net taxable gallons available for Utah fuel refund
28
(subtract line 27 from line 26)
29. Tax rate
29
.18
30. Navajo Nation fuel tax refund
30
(multiply line 28 by line 29)
31
31 Total Navajo Nation (add line 30, columns A and B)
32
32. Total refund (add lines 17, 23, and 31)
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.
Print name of applicant
Applicant’s signature
11603
Utah Refund Application General Schedule
TC-116A Rev. 9/10
Company name
Schedule type
Product type
Month/Year
1A
- Utah tax-paid gallons purchased by government entities
1H
- Gallons of aviation fuel collected at 2.5 cent tax rate
065
- Motor fuel
228 - Diesel fuel (dyed)
1B
- Utah tax-paid gallons exported from Utah
1I -
Gallons of aviation fuel collected at 4 cent tax rate
130
- Aviation fuel
260 - Repackaged lube oil
1C
- Utah tax-paid gallons purchased by Ute Indian Tribe
1J - Gallons of aviation fuel collected at 9 cent tax rate
- Diesel fuel (undyed)
1D
- Utah tax-paid gallons purchased by non-profit agricultural entities
2A
- Utah Environmental Assurance Fee paid gallons exported from Utah
224
- Compressed natural gas
1E - Eligible gallons of fuel lost or destroyed by fire, flood, crime or accident
2B
- Utah Environmental Assurance Fee paid gallons placed in nonparticipating tanks
1F - Eligible gallons for each single transaction discharged by bankruptcy
2C
- Utah Environmental Assurance Fee for repackaged
1G - Gallons returned to refinery for re-refining
3A - Gallons of fuel delivered to Utah portion of Navajo Nation
1
2
3
4
5
6
7
8
9
Purchase date
Invoice
Manifest
Facility/Terminal number
Airport code
Supplier’s
Tax-paid
(mmddyyyy)
number
Origin
Destination
(only for Sch. type 2A, 2B, 2C)
(for prod. type 130)
name
gallons
Total
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