Form Dr 309660 PDF Details

Whether you are a business involved in the marine industry or deal with pollutants subject to taxes in Florida, understanding the DR-309660 form is crucial for optimizing your financial strategies. The Florida Department of Revenue provides this form as an Application for Pollutants Tax Refund, a critical document for any entity looking to reclaim funds from the state. Designed with specificity for pollutants tax recovery, the form meticulously guides applicants through a process requiring detailed information on pollutants exported or consumed in a manner that merits a tax refund. Scheduled to be filed quarterly, this form demands careful attention to the complete provision of applicant identification, tax details, and the precise calculation of refunds sought, along with a substantiating inventory and export details. Not only does it cover petroleum products and solvents but also extends to motor oils, lubricants, and ammonia-containing products, offering a substantial breadth of tax refund opportunities. Moreover, the document underscores the importance of punctuality, documentation, and the potential implications of submission errors. With its comprehensive structure, the DR-309660 form embodies the bridge between stringent regulatory mandates and the financial recuperation available to businesses within Florida’s pollutant management framework.

QuestionAnswer
Form NameForm Dr 309660
Form Length6 pages
Fillable?No
Fillable fields0
Avg. time to fill out1 min 30 sec
Other namesdr309660 florida department of revenue power of attorney form

Form Preview Example

Florida Department of Revenue

Application for Pollutants Tax Refund

DR-309660

R. 01/11

Rule 12B-5.150

Florida Administrative Code

Effective 01/11

Complete Parts 1 through 6 and attach appropriate documentation. Type or print clearly. Your refund application will be rejected if red boxes are not completed in full.

 

Handwritten Example

 

 

Typed Example

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1

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0123456789

 

 

 

 

 

 

 

 

Use black ink.

Mail application to: Refund Subprocess

Florida Department of Revenue PO Box 6490

Tallahassee FL 32314-6490

Part 1 Fill in

Name of applicant:

 

 

Mailing street address:

 

 

Mailing city, state, ZIP:

 

 

Location street address:

 

 

Location city, state, ZIP:

 

 

Business telephone number

 

 

(include area code):

 

 

Fax number (include area

 

 

code optional):

(

)

 

Home telephone number (include area code):

E-mail address (optional):

Part 2

Sign and date this form.

Under penalty of perjury, I swear or afirm that this application, including supporting documentation, has been examined by me and is true and correct for the period stated and is made in good faith according to Chapter 206, Florida Statutes (F.S.), and the regulations issued under authority thereof.

Signature of applicant/representative:

Date:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Print name:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Title:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Important - A Florida Department of Revenue Power of Attorney (Form DR-835) must be properly executed and included if the

 

 

 

 

refund request is submitted by the applicant’s representative.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Representative’s phone number:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Part 3

$

 

 

 

 

 

 

 

 

 

,

 

 

 

 

 

 

 

 

,

 

 

 

 

 

 

 

 

 

 

 

 

 

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Enter amount of refund.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Part 4

Identiication number of applicant:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Provide the

Federal employer identiication number:

 

 

Fuel tax license number:

 

 

 

 

 

identiication number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

under which the tax

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

was paid. If you do not

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

have a federal employer

Business partner number:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

identiication number,

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

provide your social

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

security number.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Part 5

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

/

 

 

 

 

 

/

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

/

 

 

 

 

 

 

/

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Enter the period shown

Period

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

to

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

on the tax return(s)

 

 

 

 

 

 

 

 

 

M

 

 

 

M

 

 

 

D

 

D

Y Y

 

 

M M

 

 

 

D D

 

 

Y Y

 

 

 

 

 

used to report the tax

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

and/or when it was

Paid

 

 

 

 

 

 

 

 

/

 

 

 

 

 

/

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

to

 

 

 

 

 

 

/

 

 

 

 

 

 

/

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

paid.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

M M

 

 

 

D D

Y Y

 

 

M M

 

 

 

D D

 

 

Y Y

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Part 6

Reasons for this refund (additional sheets may be added):

 

 

 

 

 

 

FOR DOR USE ONLY

 

 

DOC TYPE 76

 

Clarify and speed

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

REFUND

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

up your refund claim

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

by providing a brief

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Approval Amount $ _________________________________

 

explanation.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Date ____________________________________________

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Approved by______________________________________

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Review

Refund Amount $ __________________________________

Date ____________________________________________

Approved by ______________________________________

 

Florida Department of Revenue

 

 

 

 

 

DR-309660

 

Application for Pollutants Tax Refund

 

 

 

 

 

R. 01/11

 

 

 

 

 

 

Page 2

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Coastal Protection

Water Quality

Inland Protection

Schedule A. Tax-paid petroleum bunkered in a vessel or exported

 

 

 

 

 

 

1.Beginning Inventory (Must agree with closing inventory from prior quarter)

2.Purchases (From completed Schedule 1 – Schedule of Purchases)

3.Ending inventory (Use this igure for beginning inventory on next claim)

4.Barrels consumed ( Add Lines 1 and 2. Subtract Line 3)

5.Barrels not eligible for refund

6.Barrels claimed for refund (Line 4 minus Line 5 )

7. Refund (Line 6 multiplied by the rate per barrel)

$

$

$

Schedule B. Tax-paid motor oil and lubricants bunkered in a vessel or exported

 

 

8.Beginning Inventory (Must agree with closing inventory from prior quarter)

9.Purchases (From Schedule 1- Schedule of Purchases)

10.Ending inventory (Use this igure for beginning inventory on next claim)

11.Gallons consumed ( Add Lines 8 plus 9. Subtract Line 10)

12.Gallons not eligible for refund

13.Gallons claimed for refund (Line 11 minus Line 12)

14. Refund (Line 13 multiplied by rate per gallon)

$

$

$

Schedule C. Tax-paid pollutant exported from the state by a licensee

15.Beginning Inventory (Must agree with closing inventory from prior quarter)

16.Purchases (From Schedule 1- Schedule of Purchases)

17.Ending inventory (Use this igure for beginning inventory on next claim)

18.Barrels consumed ( Add Lines 15 plus 16. Subtract Line 17)

19.Barrels not eligible for refund

20.Barrels claimed for refund (Line 18 minus Line 19)

21. Refund (Line 20 multiplied by rate per barrel)

$

$

$

Schedule D. Solvents

 

 

 

22.Beginning Inventory (Must agree with closing inventory from prior quarter)

23.Purchases (From Schedule 1-Schedule of Purchases)

24.Ending inventory (Use this igure for beginning inventory on next claim)

25.Gallons consumed ( Add Lines 22 plus 23. Subtract Line 24)

26.Gallons not eligible for refund

27.Gallons claimed for refund (Line 25 minus Line 26)

28.

Refund (Line 27 multiplied by rate per gallon)

$

$

$

 

 

 

 

 

 

29.

Total net refund requested (Add Lines 7 plus 14 plus 21 and Line 28)

$

 

 

 

30.

Less refund processing fee

$

-2.00

 

 

31.

Net refund due (Line 30 minus Line 31)

$

 

 

 

 

SCHEDULE 1

 

 

 

 

 

 

 

 

DR-309660

 

 

Purchase Invoices for Florida Pollutants Taxes Paid

 

 

 

R. 01/11

 

 

 

 

 

 

 

Page 3

 

 

 

Attachment Schedule for Pollutants Used in Marine Bunkering Engaged in Interstate or Foreign Commerce and/or Exported Out of Florida

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Company Name

 

 

 

Quarter Ending

 

Lic/FEIN

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Type of

Tax-paid

FL Pollutants

FL Pollutants

FL Pollutants

Total

 

Invoice

 

 

 

 

Gallons

Tax Paid

Tax Paid

Florida

 

Purchase Date

Supplier’s Name

Supplier’s FEIN

Supplier’s Address

Pollutant

Tax Paid

 

Number

or Barrels

Inland

Coastal

Pollutants Tax

 

 

 

 

 

Purchased

Water Quality

 

 

 

 

 

 

Purchased

Protection

Protection

Paid

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

TOTAL

 

 

 

 

 

 

 

 

 

 

 

SCHEDULE 2

 

 

 

 

 

DR-309660

 

 

Sales Invoices For Proof of Florida Pollutants Taxes Paid

R. 01/11

 

 

 

 

 

Page 4

 

 

 

Computation Worksheet for Pollutants Used in Marine Bunkering Engaged in Interstate or Foreign Commerce and/or Pollutants Exported Out of Florida

 

 

 

 

 

 

 

 

 

 

 

 

Company Name

 

 

 

Quarter Ending

Lic/FEIN

 

 

 

 

 

 

 

 

 

 

 

 

Invoice

Delivery Date

Purchaser’s Name

 

Vessel’s Name if Applicable

Point of Destination if Applicable

Gallons or Barrels Sold

Type of Pollutant

 

Number

 

(Marine Bunkering Only)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Barrels

 

x

 

=

 

Florida Water

 

sold

 

 

 

Quality Tax

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Gallons

 

x

 

=

 

Florida Water

 

sold

 

 

 

Quality Tax

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Barrels

 

x

 

=

 

Florida Inland

 

sold

 

 

 

Protection Tax

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

TOTAL REFUND

$

 

 

 

 

 

 

 

 

 

 

The refund rate for inland protection is:

.80 cents per barrel for petroleum products

The refund rate for water quality is:

.05 cents per barrel for petroleum products and all other pollutants not listed

.02 cents a barrel for ammonia

.059 cents per gallon for solvents

.025 cents per gallon for motor oil and lubricants

Important Information Concerning Pollutants Tax Returns

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R.01/11 Page 5

1.Only persons licensed according to Chapter 206, F.S., can apply for a pollutant tax refund. Refund applicants are entitled to a refund of:

A.Tax-paid petroleum products exported from the state or bunkered into marine vessels engaged in interstate or foreign commerce.

1)Refund of 5 cents per barrel levied under

s.206.9935(2), F.S., (Tax for Water Quality).

2)Refund of 80 cents per barrel levied under

s.206.9935(3), F.S., (Tax for Inland Protection).

B.Tax-paid motor oil and lubricants products exported from the state or bunkered into marine vessels engaged in interstate or foreign commerce.

1)Refund of 2.5 cents per gallon levied under

s.206.9935(2), F.S., (Tax for Water Quality) for motor oil and lubricants.

C.Tax-paid ammonias or products containing ammonia exported from the state.

1)Refund of 2 cents per barrel levied under

s.206.9935(2), F.S., (Tax for Water Quality) for ammonia.

2)The timing of the refund claim is based on the date on which the pollutant or the product containing the pollutant was exported and not the date on which the pollutant was originally purchased.

D.Tax-paid solvents exported or consumed in the manufacture or production of a product that is not a pollutant or consumed, blended, or mixed to produce a pollutant that is subject to the tax for water quality.

1)Refund of 5.9 cents per gallon levied under

s.206.9935(2), F.S., (Tax for Water Quality).

2.Applications are to be used only for the quarter indicated on the face of this application. Only original refund applications are acceptable. Application forms may

be requested by contacting the Refund Section of the Department of Revenue at (850) 617-8585.

3.Claims must be iled quarterly, no later than the last day of the month immediately following the quarter. The iling date may be extended one additional month only if a justiied excuse is submitted in writing with the claim and only if the prior quarter’s claim was iled on time.

4.Amended applications for the prior calendar quarter must be received by the Department by the current calendar quarter’s deadline. A refund will not be authorized for an amount less than $5 for any given period.

Purchases Made

Claims Must Be Filed By*

With A Written Excuse –

During

No Later Than

 

 

 

 

January, February,

April 30

May 31

and March

 

 

 

 

 

April, May, and June

July 31

August 31

 

 

 

July, August,

October 31

November 30

and September

 

 

 

 

 

October, November,

January 31

February 28

and December

 

 

 

 

 

*Amended application for prior quarter must be received by current quarter’s deadline. Example: An amended March quarterly application must be submitted by July 31.

5.Effective January 1, 2000, the Department will pay interest on refunds of this tax if the refund has not been paid or credited within 90 days of receipt of a complete application for refund. A complete application will contain documentation establishing the overpayment. Interest paid by the Department will be computed beginning on the 91st day based upon a statutory loating interest rate that may not exceed 11%. Interest rates are updated January 1 and July 1 of each year.

6.The request for refund must be supported by purchase invoices, charge tickets, sales slips, or other tangible evidence that supports the validity of the refund claim. Evidence may include items such as tax-paid invoices, applicable export schedules, and/or shipping and delivery documents.

A.Purchase invoices verifying the payment of taxes imposed under s. 206.9935, F.S., should contain the following information:

Invoice number

The name, mailing address, and location address of the supplier

Type of pollutant and the number of gallons or barrels purchased

Purchase date

The pollutant tax paid per gallon or per barrel

The Department of Environmental Protection storage tank facility identiication number for the supplier, if applicable, or supplier’s Federal Identiication Number (FEIN)

If a taxpayer is remitting pollutants tax via Form DR-904 (Pollutants Tax Return), a copy of the DR-904 must be provided at the time of refund submission.

B.Sales invoices should contain the following:

Invoice number

Delivery date

Purchaser’s name

Vessel’s name (if applicable)

Point of destination (if applicable)

Gallons or barrels sold

Type of pollutant

Instead of original purchase and sales invoices, you may submit schedules provided they include the information required above.

7.First-time users of this form must provide proof of pollutants tax paid by submitting either invoices or Form DR-904. If beginning inventory is being claimed, proof of pollutants tax paid for the beginning inventory must be provided either by invoices or by Form DR-904.

8.In the event of an overpayment of any refund, the Department will refuse to make further refunds and advise the payee of the amount to be reimbursed.

9.A processing fee of $2.00 will be deducted from each claim.

10.Any person licensed according to Chapter 206, F.S., who is eligible for a refund according to s. 206.9942, F.S., may, take a credit on the monthly Pollutants Tax Return (Form DR-904), instead of applying for a refund. The credit taken must not exceed the tax imposed on those gallons which would otherwise be eligible for refund. Any request for credit must be supported by a charge ticket, sales slip, invoice, or other tangible evidence of the sale showing the tax was paid to the state or supplier; applicable export schedules; and shipping and delivery documents.

DR-309660 Line-By-Line Instructions

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R.01/11 Page 6

Schedule A Tax-paid petroleum products exported from the state or bunkered into a marine vessel engaged in interstate or foreign commerce by a licensed terminal supplier, importer, exporter, producer, wholesaler, or dealer.

Line 1. Beginning inventory – Must agree with closing inventory from prior quarter. If prior quarters claim was not iled, enter “0”.

Line 2. Barrels purchased – This represents petroleum products purchased during this calendar quarter. The information provided with Schedule 1 must support these purchases.

Line 3. Ending inventory2 – Actual physical inventory as of the last day of this quarter. This will be the beginning inventory for the next quarter. If no refund is due but a closing inventory exists, the claim form must be iled.

Line 4. Total barrels consumed – Line 1 plus Line 2 minus Line 3.

Line 5. Barrels not eligible for refund – This represents petroleum products which were not exported from the state or bunkered into a marine vessel engaged in interstate or foreign commerce.

Line 6. Barrels claimed for refund – This represents petroleum products that were exported from the state or bunkered into a marine vessel engaged in interstate or foreign commerce.

Schedule B Tax-paid motor oil and lubricants products exported from the state or bunkered into a marine vessel engaged in interstate or foreign commerce by a licensed terminal supplier, importer, exporter, producer, wholesaler, or dealer.

Line 8. Beginning inventory – Must agree with closing inventory from prior quarter. If prior quarters claim was not iled, enter “0”.

Line 9. Gallons purchased – This represents motor oil and lubricant products purchased during this calendar quarter. The information provided with Schedule 1 must support these purchases.

Line 10. Ending inventory2 – Actual physical inventory as of the last day of this quarter. This will be the beginning inventory for the next quarter. If no refund is due but a closing inventory exists, the claim form must be iled.

Line 11. Total gallons exported – Line 8 plus Line 9 minus Line 10.

Line 12. Gallons not eligible for refund – This represents motor oil and lubricant products which were not exported from the state or bunkered into a marine vessel engaged in interstate or foreign commerce.

Line 13. Gallons claimed for refund – This represents motor oil and lubricant products that were exported from the state or bunkered into a marine vessel engaged in interstate or foreign commerce.

Schedule C Tax-paid pollutants produced in, imported into, or purchased in this state and said pollutants or products containing said pollutants are exported from this state.

Line 15. Beginning inventory – Must agree with closing inventory from prior quarter. If prior quarters claim was not iled, enter “0”.

Line 16. Barrels purchased1 – This represents pollutant products purchased during this calendar quarter. The information provided with Schedule 1 must support these purchases.

Line 17. Ending inventory2 – Actual physical inventory as of the last day of this quarter. This will be the beginning inventory for the next quarter. If no refund is due but a closing inventory exists, the claim form must be iled.

Line 18. Total barrels exported – Line 15 plus Line 16 minus Line 17.

Line 19. Barrels not eligible for refund – This represents pollutants or products containing said pollutants which were not exported from the state.

Line 20. Barrels claimed for refund – This represents pollutants or products containing said pollutants which were exported from the state.

Schedule D Tax-paid solvents exported or consumed in the manufacture or production of a product that is not a pollutant or tax-paid solvents which were subsequently consumed, blended, or mixed to produce a pollutant that is subject to tax.

Line 22. Beginning inventory – Must agree with closing inventory from prior quarter. If prior quarters claim was not iled, enter “0”.

Line 23. Gallons purchased1 – This represents solvents purchased during this calendar quarter. The information provided with Schedule must support these purchases.

Line 24. Ending inventory2 – Actual physical inventory as of the last day of this quarter. This will be the beginning inventory for the next quarter. If no refund is due but a closing inventory exists, the claim form must be iled.

Line 25. Total gallons consumed – Line 22 plus Line 23 minus Line 24.

Line 26. Gallons not eligible for refund – This represents solvents which were not exported or consumed in the manufacture or production of a product that is not a pollutant or solvents which were not subsequently consumed, blended, or mixed to produce a pollutant that is subject to tax.

Line 27. Gallons claimed for refund – This represents the total solvents which were exported or consumed in the manufacture or production of a product that is not a pollutant or solvents which were subsequently consumed, blended, or mixed to produce a pollutant that is subject to tax.

1To convert solid pesticides and liquid ammonia from pounds to gallons, 10 pounds of solid pesticides equals one gallon and 5.14 pounds of ammonia at 60 degrees Fahrenheit equals one gallon. One barrel is the equivalent of 42 gallons.

2Pollutant products are considered a part of ending inventory until sold or exported.