1. Clear form
Fuel
Utah State Tax Commission
Application for Fuel Tax Refund TC -129
Rev. 7/08
on Re-refined Mixed Fuel
Telephone: (801) 297-2200 for assistance
(1-800-662-4335 outside Salt Lake City but inside Utah)
Get forms online - tax.utah.gov
Claimant’s name (retailer, wholesaler or licensed fuel tax distributor) Federal identification or Social Security no.
Claimant’s mailing address
City, State, ZIP code
Name of refinery fuel returned to
Date of incident Time of incident Location of incident
Brief explanation of the incident:
Attachments Required
1. Copies of all original invoices or bills-of-lading for re-refined fuel gallons shown below, and
2. Written verification from refinery certifying:
a. Number of gallons returned to refinery for re-refining; and
b. Date fuel was returned to refinery for re-refining.
Gallons Tax paid Refund claimed
1. Motor fuel eligible for refund
2. Aviation fuel eligible for refund
3. Special fuel eligible for refund
4. Dyed diesel fuel gallons not eligible for refund
5. Total refund of all eligible fuel tax (add quot;Refund claimedquot; column, lines 1, 2 and 3). This is your TOTAL REFUND $
Affidavit of Claimant
I certify that I meet all the conditions to qualify for this refund. I have examined this refund application, including
all required attachments, and certify that to the best of my knowledge it is true, correct and complete.
Print name of person signing claim Name of contact person, if different
Signed Date signed Title Telephone
X
STATE OF UTAH SS
COUNTY OF _________________________________
On this ______ day of _________________, in the year 20_______, before me personally appeared __________________________________
to me known and known to me to be the person, and described in, and who executed the foregoing instrument, and acknowledged to me that he
executed the same. (NOTARY SEAL)
Notary Public
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. Eligibility and General Information
1. Utah law (59-13-202.5) allows retailers, wholesalers or licensed distributors to claim a refund of
Utah fuel tax paid on motor fuel if:
dyed diesel fuel or special fuel is mixed with motor or aviation fuel; and
●
the mixed motor or aviation fuel is returned to the refinery for re-refining.
●
2. Utah law (59-13-322) allows retailers, wholesalers, licensed distributors or licensed suppliers to
claim a refund of Utah fuel tax paid on special fuel if:
dyed diesel fuel is mixed with special fuel; and
●
the mixed special fuel is returned to the refinery for re-refining.
●
3. You must attach copies of all original invoices or bills of lading showing Utah fuel tax paid for the
fuel gallons included in this refund application:
For motor or aviation fuel, attach copies of bill(s) of lading.
●
For special fuel, attach copies of original invoice(s).
●
4. You must attach written verification from a refinery showing:
the number of gallons of mixed motor, aviation or special fuel returned to the refinery
●
for re-refinement;
the date the mixed motor or special fuel gallons were returned to the refinery; and
●
that Utah motor, aviation or special fuel tax was paid on the mixed fuel returned to be
●
re-refined.
5. You must have your claim notarized.
6. You must file your application for refund or credit with the Tax Commission within 90 days of the
date the motor fuel, special fuel or aviation fuel was returned to the refinery for re-refinement.
Mailing address:
Utah State Tax Commission
210 N 1950 W
Salt Lake City UT 84134