Official Connecticut Au 738 Template in PDF

Your motor vehicle fuels tax refund claim for fuel used during calendar year 2004 must:

1.Be filed with Department of Revenue Services (DRS) on or before May 31, 2005; and

2.Involve at least 200 gallons of fuel eligible for tax refund.

The appropriate fuel type box must be marked on the front of this form in order to process this claim. You must file a separate Form AU-738 for each motor vehicle fuel type.

Be sure to provide a telephone number where you can be contacted.

You must indicate your Connecticut tax registration number or Social Security Number in the space provided.

For all purchases of fuel listed, you must attach a copy of each numbered slip or invoice issued at the time of the purchase. The slip or invoice may be the original or a photocopy and must show the:

•Date of purchase;

•Name and address of the seller (which must be printed or rubber stamped on the slip or invoice);

•Name and address of the purchaser (which must be the name and address of the person or entity filing the claim for refund);

•Number of gallons of fuel purchased;

•Price per gallon;

•Total amount paid; and

•If payment is made within a discounted period, provide proof of amount paid.

You must retain records to substantiate your refund claim for at least three years following the filing of the claim and make them

Table of Motor Vehicle Fuels Tax Refund Rates for 2004

for Nutrition Program

Note: You must file a separate Form AU-738 for each motor vehicle fuel type.

available to DRS upon request.

Rounding Off to Whole Dollars: You must round off cents to the nearest whole dollar on your motor vehicle fuels tax refund claim. Round down to the next lowest dollar all amounts that include 1 through 49 cents. Round up to the next highest dollar all amounts that include 50 through 99 cents. However, if you need to add two or more amounts to compute the total to enter on a line, include cents and round off only the total.

Example: Add two amounts ($1.29 + $3.21) to compute the total ($4.50) to enter on a line. $4.50 is rounded to $5.00 and entered on the line.

You must attach a copy of your contract with your local area agency on aging as evidence of your eligibility to provide Title III-C meals to senior citizens.

Mail the completed refund application to: Department of Revenue Services State of Connecticut

Excise Taxes Unit

25 Sigourney Street Hartford CT 06106-5032

Additional Information

If you need additional information or assistance, please call the Excise Taxes Unit at 860-541-3224, Monday through Friday, 8:00 a.m. to 5:00 p.m. Forms may be downloaded from our Web site at

www.ct.gov/DRS

Your refund will be applied against any outstanding DRS tax liability.