Social Security: taxtype62ina-2007-enabled

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North Dakota Office of State Tax Commissioner Claim for Tax Refund by Individual Native American Special Fuel - Tax Type 62 For period from Name of Claimant: month 2007 through month Social Security No.: Tribal ID: 3 0 __ U __________ Address: City & State: Telephone No.: Zip Code: When to File Claim A claim for a refund of special fuel (undyed diesel fuel) taxes of $5.00 or more may be filed by an individual Native American claimant. A claim covering tax on special fuel purchased during
  North Dakota Office of State Tax Commissioner Signature of claimant (required)DateTelephone Number I declare under the penalties of North Dakota Century Code § 12.1-11-02, which provides for a Class A misdemeanor for making a false statement in agovernmental matter, that this return, including any accompanying schedules and statements, has been examined by me and to the best of myknowledge and belief is a true, correct and complete return. DateSignature of preparer other than claimant 2007 Claim for Tax Refund by Individual Native AmericanSpecial Fuel - Tax Type 62 Name of Claimant:Address:City & State:Social Security No.:Telephone No.:Zip Code: A claim for a refund of special fuel (undyed diesel fuel   ) taxes of $5.00 or more may be filed by an individual NativeAmerican claimant. A claim covering tax on special fuel purchased during calendar year 2007 may be filed: Note - The claim for a refund of taxes paid on special fuel (undyed diesel) purchased in 2007must be filed no later than June 30, 2008.Claimant's Declaration of Eligibility - Claimant must meet ALL of the following:Verification of Special Fuel Purchases: The claimant must provide detailed proof of purchases in the form of srcinal invoices or certified histories. Refund Calculations ATTACHED ORIGINAL INVOICES OR A CERTIFIED HISTORY REQUIRED 1. Enter total gallons of  undyed diesel fuel purchased . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .a. Any time between January 1, 2008 and June 30, 2008.b. Any time during the year the fuel was purchased when the refundable taxes reach $400 or more. Mail to: Office of State Tax Commissioner600 E. Boulevard Ave., Dept. 127Bismarck ND 58505-0599 When to File Claim For period fromthrough monthmonth See the information and instructions on the reverse side of the form. 2. Refund Payable - $.23 times Line 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Round GallonsTo Nearest Gallon .0$ Tribal ID: The claimant is an enrolled member of a Native American Tribe whose reservation is located in North Dakota.The special fuel on which the refund claim is based was purchased from a retailer or distributor on the reservationwhere the claimant is an enrolled member.The North Dakota special fuel taxes were billed directly to the claimant.The claimant has paid the North Dakota tax to the seller of the fuel. 3 0 __ U __________  Instructions An individual Native American may file a claim for a refundof North Dakota special fuel (undyed diesel) taxes provided:ã The claimant is an enrolled member of a Native AmericanTribe whose reservation is located in North Dakota.ã The special fuel on which the refund claim is based was purchased from a retailer or distributor on the reservationwhere the claimant is an enrolled member.ã The North Dakota special fuel taxes were billed directly tothe claimant.ã The claimant has paid the North Dakota tax to the seller of the fuel. Form: Use the form prescribed by the Tax Commissioner. Enter your social security number, your tribal identificationnumber, name, and address in the appropriate spaces.Complete the form in its entirety and be sure to sign anddate it. The claimant is directly responsible for the accuracyof the information. FUEL DEALERS ARE PROHIBITEDBY LAW FROM PREPARING REFUND CLAIMS FOR CONSUMERS. Original Invoices or Sales Tickets: Invoices, sales tickets, or certified listings which do notcontain the required information will not be accepted,and the entire claim may be denied. The law requires that invoices or sales tickets, or certifiedlistings, detailing fuel purchases be submitted with claimsfor tax refunds. The information on these documents must be entered by the seller of the fuel. The law specifies thateach invoice or sales ticket must include:ã The seller’s name and address;ã The date the fuel was purchased;ã The type of product;ã The number of gallons of special fuel purchased;ã The state tax as a separate item or a statement thatthe state tax is included in the price (not required for  purchases after June 30, 2007); andã The name of the claimant.In addition, there should be a document number on theinvoice or sales ticket.The invoices or sales tickets must be ORIGINALS; and if the srcinal invoices or sales tickets are lost, the claimantmay substitute duplicates plus a separate affidavit on forms prescribed by the Tax Commissioner.If there are 50 or more srcinal invoices or sales tickets,those documents must be organized, as follows:ã In groups by seller of the fuel;ã In sequential order by document number within each“seller” group.ã With detailed and summarized gallonage totals attachedto each group. Certified Histories – In Lieu of Original Invoices: A claimant may submit certified histories detailing therequired information. CERTIFIED HISTORIES MUSTBE PREPARED BY THE SELLER OF THE FUEL. Thehistories must detail each purchase of fuel on which arefund is claimed. The histories must include certificationstatements verifying that the information is a true andcorrect record of sales to the specific consumer; that srcinaldocumentation is available for audit purposes; and, if thestate tax is not listed as a separate item, that the tax wasincluded in the price. Audits: Tax refund claims are subject to audit by the TaxCommissioner. An audit may be conducted any time withinthree years after the due date of the claim or within threeyears after the claim was filed, whichever occurs later.When a claim is selected for audit, the claimant is expectedto provide any additional information required by the TaxCommissioner. Instructions for Lines 1 – 2:Line 1: Enter the total gallons of undyed diesel fuel purchased during the calendar year 2007. Line 2: Compute the tax paid on the net gallons subject torefund. Multiply $.23 times the gallons on line 1. If You Need Assistance If there are questions concerning the claim or theinvoices, please contact the Motor Fuel Tax Section at701-328-3382 or e-mail us at fueltax@nd.gov. 22968(Revised 5-2007)
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