1. Name Federal ID (FEIN/EIN)
EX-RF
Rev. 1/01
TC-943
(1-800-662-4335 outside Salt Lake City but inside Utah)
Filing period (Begin: mmyy End: mmyy)
Street address
Telephone: (801) 297-2200 for assistance
Begin: End:
City, State, ZIP code
Application For Exported
Tax Paid Diesel Refund
Utah State Tax Commission
Refund application may not be filed more often than on a monthly basis. Clear form
Enter the state exported to (complete separate form for each state) License and account number in destination states
Point of origin Document number
Destination Product
Terminal # Tax paid
Gallons
Carrier Customer’s name Customer FEIN Date shipped Invoice number Bill-of-lading
City,State
City, State type
TOTAL
I certify that I meet all the conditions to qualify for this refund. I have examined this refund application, including
GALLONS
any accompanying schedules, and certify that to the best of my knowledge it is true, correct and complete.
TOTAL
Signed Date signed Title Telephone REFUND
X
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.

2. General Information
Utah Code Section 59-13-301 allows for a refund of Utah tax paid on undyed diesel fuel exported from Utah.
The exporter may obtain a refund of the special fuel taxes paid by filing form TC-943, Refund For Exports of Tax
Paid Diesel, within 180 days of exporting the fuel.
If you need additional help or information, contact the Utah State Tax Commission at
(801) 297-2200 or if outside the Salt Lake area, call 1-800-662-4335.
Original records supporting the refund claim must be maintained by the exporter for three years
following the year of refund. Copies of the supplier invoice, shipping document, and customer invoice
must be submitted with this request.
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.
Instructions For Completing This Form
Enter the full name, physical and mailing address, Federal Identification or Social Security Number of the
exporter applying for the refund in the space provided. Use this name and number whenever you file for a
refund. Enter the month and year of the refund period and your telephone number.
You must provide all information requested for each export for which you are claiming a refund.
Complete a separate form for each state Utah tax paid undyed diesel fuel is exported to for the refund period.
Attach additional forms if necessary.
Include the license or account number for each destination state.