Form 4924 PDF Details

The Missouri Department of Revenue provides a crucial tool for entities seeking refunds on motor fuel through the 4924 form. This form encompasses a variety of uses, from agricultural to aviation, pinpointing the diverse needs of Missouri residents and businesses when it comes to fuel tax refunds. Whether it's fuel used in farm equipment, construction machinery, marine watercraft, or for heating purposes, the form allows applicants to detail their specific usage and claim a refund appropriately. Moreover, it caters to more specialized categories like fuel used in refrigerated units (reefer use) and for power take-off purposes, illustrating the department's consideration for the wide-ranging applications of fuel beyond just powering vehicles on the road. The process also accounts for those exempt from Missouri sales tax, requiring documentation for exemption verification. Retailers making bulk deliveries, selling kerosene, or involved in transactions with the federal government and public mass transportation operators are also addressed, ensuring a comprehensive approach to the spectrum of fuel usage across the state. The requirement for thorough documentation, including the need for additional forms in certain cases, highlights the department's commitment to accurate and justified tax refund claims, reflecting a structured approach to taxation and refunds within Missouri.

QuestionAnswer
Form NameForm 4924
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesmo form 4925, missouri form 4924, missouri gas tax refund form 4925, missouri fuel tax refund form 4924

Form Preview Example

MISSOURI DEPARTMENT OF REVENUE

FORM

FOR DOR USE ONLY

TAXATION DIVISION

 

 

 

P O BOX 800, JEFFERSON CITY, MISSOURI 65105-0800

4924

 

 

 

 

(573) 751-7671 TDD (800) 735-2966

 

 

(REV. 03-2011)

 

MOTOR FUEL REFUND APPLICATION

 

Keyed Date: ___________________________________

 

 

 

 

 

 

 

 

 

 

PLEASE PRINT OR TYPE — SEE INSTRUCTIONS ON BACK

 

 

 

 

CLAIMANT’S NAME

 

 

 

 

 

FEIN, SOCIAL SECURITY NUMBER OR DRIVER LICENSE NUMBER

 

 

 

 

 

 

__ __ __ __ __ __ __ __ __ __ __ __ __ __ __

 

 

 

 

 

 

 

 

 

PHYSICAL ADDRESS

 

 

 

 

 

MAILING ADDRESS

 

 

 

 

 

 

 

 

 

CITY OR TOWN, STATE, ZIP CODE

 

 

 

 

 

CITY OR TOWN, STATE, ZIP CODE

 

 

 

 

 

 

COUNTY OF PHYSICAL ADDRESS

LOCATION OF PHYSICAL ADDRESS (Check One)

 

 

E-MAIL ADDRESS

 

INSIDE CITY LIMITS

OUTSIDE CITY LIMITS

 

 

 

 

 

 

 

 

TELEPHONE NUMBER

 

ALTERNATE TELEPHONE NUMBER

 

 

FAX NUMBER

( __ __ __ ) __ __ __ - __ __ __ __

( __ __ __ ) __ __ __ - __ __ __ __

( __ __ __ ) __ __ __ - __ __ __ __

 

 

 

 

 

 

 

 

 

Are you exempt from Missouri sales tax?

Yes

No

(If yes, attach a copy of your sales/use tax exemption letter or complete

the Form 149, Sales/Use Tax Exemption Certificate and submit it along with this form.)

Please check all applicable boxes. Please review instructions on back.

Agricultural Use

List farm equipment: _______________________________________________________________________________________________

Physical location of farm in Missouri: __________________________________________________________________________________

County: _________________________________________________________________________________________________________

Number of acres owned or leased: _______________________

Number of acres in cultivation: ___________________________

Custom work performed?

Yes

No

Type of custom work: __________________________________

No Farm - Residential/Personal off-road use only (includes residential lawn mowers, ATV’s, chain saws, weed eaters, etc.)

Commercial Use - (Includes lawn care services, golf courses and construction companies).

List off-road equipment: _____________________________________________________________________________________________

Reefer Use

Indicate number of reefer units being used: _____________________________________________________________________________

Marine Use

List watercraft: ____________________________________________________________________________________________________

Power Take-Off (PTO) Use

List type of vehicle operation: ________________________________________________________________________________________

Heating Use

Home heating % ____________

Business heating % _____________

Aviation Use

Commercial agricultural use

Business use

Recreational use

Ingredient or Component Part

Describe use: ____________________________________________________________________________________________________

Retailer making bulk deliveries to farmers (Effective 1-1-06)

Must have Agricultural Gasoline Bulk Sale Exemption Certificate (Form 5084) on file.

Retailer Selling Kerosene

Barricaded pumps (attach copy of IRS certification)

Non-barricaded pumps in quantities of 21 gallons or less

Motor Fuel Sold To or Purchased By Federal Government

Retailers list the branch name and address of the government agency to whom sales will be made: _________________________________

________________________________________________________________________________________________________________

Motor Fuel Sold To or Purchased By Public Mass Transportation Operator (Effective 8-28-07)

Retailers list the name and address of the public mass transportation service to whom sales will be made: ____________________________

________________________________________________________________________________________________________________

Other Usage - Describe use and equipment: ____________________________________________________________________________

BULK FUEL STORAGE CAPACITY (TANK SIZE):

Gasoline — Road use: ________________________________

Gasoline — Off-road use: ___________________________________

Clear Diesel: _________________________________________

Dyed Diesel: ____________________________________________

$.09 Aviation Gasoline: ___________________________________ Other — List product: ___________________________________

If no bulk storage, explain how fuel is received: ____________________________________________________________________

CLAIMANT’S SIGNATURE

TITLE, IF APPLICABLE

PRINT NAME

DATE

__ __ /__ __ /__ __ __ __

MO 860-2974 (03-2011)

This publication is available upon request in alternative accessible format(s).

INSTRUCTIONS FOR COMPLETING MOTOR FUEL REFUND APPLICATION

This motor fuel refund application must be completed to substantiate your refund claims. The information will be retained in our files. If the infor- mation changes, please submit a new application with the updated information. Please complete all information that applies to your situation.

CLAIMANT'S NAME AND PHYSICAL ADDRESS: Enter the claimant’s name, physical address, city, state, and zip code. The physical address must be a street or rural route number. Do not enter a Post Office Box number. Please enter a mailing address if it is different than the physical address.

FEDERAL IDENTIFICATION, SOCIAL SECURITY NUMBER, OR DRIVER LICENSE NUMBER: List your Federal Identification Number (FEIN), Social Security Number, or Driver License Number.

COUNTY OF PHYSICAL ADDRESS: Enter the county of the claimant’s physical address.

LOCATION OF PHYSICAL ADDRESS: Circle either Inside or Outside the city limits to indicate whether your physical address is located within the boundaries of a city.

E-MAIL ADDRESS/TELEPHONE NUMBER/ALTERNATE PHONE NUMBER/FAX NUMBER: Enter the appropriate information in each box.

SALES TAX EXEMPTION: Check the appropriate box. If your company is exempt from Missouri state sales tax, attach a copy of your Sales/Use Tax Exemption Letter or complete the Form 149, Sales/Use Tax Exemption Certificate and submit it with this form.

AGRICULTURAL USE: List number and type of farm equipment (i.e., 4 tractors, 1 combine, etc.), the physical location and county where the farm is located, the number of acres owned or leased and the number of acres in cultivation. Indicate if you perform custom work and if so, describe the type of work. This category includes motor fuel used in residential/personal off-road equipment such as lawn mowers, ATV’s, chain saws, weed eaters, etc.

COMMERCIAL USE: List the number and type of equipment (i.e., 3 bulldozers, 4 caterpillars, 5 lawnmowers, etc.). Include lawn care services, golf courses and construction equipment.

REEFER USE: List the number of reefer units that travel through or in Missouri.

MARINE USE: List the number and type of watercraft (i.e., 2 boats, 1 waverunner, etc.). You are required to complete and submit a Schedule A (Form 4925) with each refund claim.

PTO USE: List the type of vehicle operation. You are required to complete and submit a Schedule C with each refund claim.

HEATING USE: Check the box(es) that apply. Indicate the percentage of fuel used for each type of heating. Fuel used for heating a business is subject to applicable sales tax.

AVIATION USE: Check the box(es) that apply.

INGREDIENT OR COMPONENT PART: Describe the finished product and how the fuel is used as an ingredient or component part.

RETAILERS MAKING BULK DELIVERIES TO FARMERS: Bulk sales of one hundred gallons or more of gasoline delivered to farmers. Form 5084, Agricultural Gasoline Bulk Sale Exemption Certificate must be retained in your files.

RETAILERS SELLING KEROSENE: Check the box(es) that apply. If the kerosene is being sold through barricaded pumps, submit a copy of the IRS certification. If the kerosene is being sold through non-barricaded pumps in quantities of 21 gallons or less, you are required to submit the original invoices or sales slips with each claim.

MOTOR FUEL SOLD TO OR PURCHASED BY THE FEDERAL GOVERNMENT: Retailers list the branch name and address of the govern- ment agency to whom sales will be made.

MOTOR FUEL SOLD TO OR PURCHASED BY PUBLIC MASS TRANSPORTATION OPERATOR (Effective 8-28-07): Retailers list the name and address of the public mass transportation service to whom sales will be made. Form 5141, Public Mass Transportation Operator Exemption Certificate must be retained in your files.

OTHER USAGE: If you have other situations that are not covered above, describe in detail your operations, list equipment used and how the tax paid fuel is used for off-road purposes that may qualify for a refund. Attach an additional sheet if needed.

BULK STORAGE: Indicate the total storage capacity (tank size) for each product type. If you do not have bulk storage in Missouri, describe how fuel is received (i.e., fuel is placed directly into equipment from a tank wagon delivery truck, fuel is placed directly into equipment at service station, etc.)

CLAIMANT’S SIGNATURE: Application must be signed and dated. Print or type the name of the person signing the form. Provide title, if applicable.

If you have questions please contact the Missouri Department of Revenue, Taxation Division, P.O. Box 800, Jefferson City, Missouri 65105-0800 or call (573) 751-7671 (TDD (800) 735-2966) or e-mail this office at excise@dor.mo.gov. You may also access a copy of this form on the Department’s web site: http://dor.mo.gov/tax/forms/index.php?category=18.

MO 860-2974 (03-2011)

How to Edit Form 4924 Online for Free

missouri gas tax refund form 4925 can be filled out online with ease. Just make use of FormsPal PDF editing tool to accomplish the job in a timely fashion. Our editor is constantly evolving to present the best user experience achievable, and that's due to our commitment to continual enhancement and listening closely to user comments. Here is what you would have to do to get going:

Step 1: Simply click the "Get Form Button" above on this webpage to access our pdf file editor. Here you will find all that is necessary to fill out your file.

Step 2: With our handy PDF editing tool, you could do more than merely fill out blank form fields. Express yourself and make your docs appear sublime with customized text added, or modify the original input to excellence - all that comes with an ability to add any type of photos and sign the document off.

This PDF form will require specific info to be typed in, hence ensure you take the time to provide exactly what is required:

1. Begin filling out the missouri gas tax refund form 4925 with a selection of essential fields. Consider all of the information you need and make certain absolutely nothing is missed!

Part # 1 in completing mo form 4925

2. Your next part is to fill out all of the following fields: Commercial Use Includes lawn care, Home heating, Business heating, Aviation Use, Commercial agricultural use, Recreational use, Business use, Must have Agricultural Gasoline, Retailer Selling Kerosene, Barricaded pumps attach copy of, BULK FUEL STORAGE CAPACITY TANK, Gasoline Road use Gasoline, and Clear Diesel Dyed Diesel.

mo form 4925 writing process explained (step 2)

Lots of people frequently get some things wrong while completing Recreational use in this section. Don't forget to double-check what you enter here.

3. This next segment will be focused on Clear Diesel Dyed Diesel, Aviation Gasoline Other List, If no bulk storage explain how, CLAIMANTS SIGNATURE, TITLE IF APPLICABLE, PRINT NAME, DATE, and This publication is available upon - complete every one of these fields.

mo form 4925 writing process explained (step 3)

Step 3: Ensure the information is accurate and click on "Done" to continue further. Join FormsPal now and instantly gain access to missouri gas tax refund form 4925, all set for downloading. Each and every edit you make is conveniently preserved , so that you can change the file at a later time when required. When using FormsPal, you're able to fill out documents without stressing about database incidents or records being distributed. Our protected software helps to ensure that your private information is stored safely.