This document is an application for a motor fuel tax refund from the Utah State Tax Commission. It requests information such as the applicant's name, federal identification number, mailing address, refund period, and itemized invoices for fuel purchases with tax paid during that period. The applicant certifies the accuracy of the application and that they qualify for the refund. General instructions are provided on eligibility, filing deadlines, record keeping requirements, and how to complete and submit the form.

1. Clear form
MG-RF
Utah State Tax Commission
Application For Government TC -114M
Rev. 7/04
Motor Fuel Tax Refund
Telephone: (801) 297-2200 for assistance
(1-800-662-4335 outside Salt Lake City but inside Utah)
Name Federal identification number
Filing period (Begin: mmyy End: mmyy)
Mailing address
Begin: End:
City, State, ZIP code
Refund application may not be filed more often than on a quarterly basis.
Motor fuel
Number of
Invoice Transaction
Vendor’s name and address tax paid
GALLONS
number date
1. Total gallons (add quot;Number of Gallonsquot; column) 1
2. Total Motor Fuel Tax Paid (add quot;Motor fuel tax paidquot; column).
2
This is your TOTAL REFUND
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 person signing this form Title
Date signed
Signed Telephone number
X
If you need an accommodation under the Americans with Disabilities Act, contact the Tax Commission at (801) 297-3811
(TDD (801) 297-2020). Please allow three working days for a response.

2. General Information
Utah Code Section 59-13-201(7) allows federal and Utah state and local government entities to file for a
refund of Utah motor fuel tax paid on motor fuel purchases. For purposes of this law, motor fuels are
defined as gasolines.
Refund claims for Motor Fuel taxes paid may be filed after the end of any calendar quarter, for taxes accumulated
for that calendar quarter.
Government entities that are members of (participate in) the State Fuel Network (Network) and use gascards
through Fleet Services may not request a fuel tax refund directly from the Tax Commission. Fleet Services will
handle all fuel tax refunds for members of the Network, including purchases made outside of the Network.
Refund claims or an agreement to extend must be filed within 3 years from the date of over payment.
See Utah Code 59-13-210(7).
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.
Instructions For Completing This Form
Enter the full name, address (where refund or correspondence is to be sent) 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 motor fuel for which you
paid Utah motor fuel taxes. Attach additional forms if necessary. Do not include tax-exempt fuel
purchases (no fuel tax shown on invoice).
Filing period is a calendar quarter that begins with the first day of the calendar quarter and ends with the
last day of the calendar quarter.
Calendar quarters are January_March, April_June, July_September and October_December.
You may include multiple calendar quarters, but you must begin and end with complete calendar quarters.
Example: April_September 2004 covers two complete calendar quarters. Do not submit claims for incomplete or
combination of incomplete calendar quarters, such as May_August.