Application for Refund of Gasoline Tax
Transcription
Application for Refund of Gasoline Tax
? NOTE: You can fill out these fields for printing, but cannot save the values here Application for Refund of Gasoline Tax (Pursuant to the Prince Edward Island Gasoline Tax Act and the Revenue Administration Act R.S.P.E.I. 1988) M ail to: Finance, Energy and Municipal Affairs, Taxation and Property Records PO Box 1150, Charlottetown, PE C1A 7M8 For more information: Tel: (902) 368 5703 Fax: (902) 368 6164 W ebsite: www.taxandland.pe.ca Em ail: [email protected] Deliver to: 95 Rochford Street Shaw Building, 1 st Floor Charlottetown, PE C1A 3T6 or: any Access PEI Centre Freedom of Information and Protection of Privacy Personal information on this form is collected under the authority of Section 31(c) of the Freedom of Information and Protection of Privacy Act and will be used for the purposes of tax administration and enforcement. Questions on the collection and use of this information can be directed to the Manager, Corporate and Tax Administration Services, PO Box 2000, Charlottetown, PE C1A 7N8 (902) 368-5137. Please complete all sections in detail Section A – Claimant Information (please print) Nam e [must include m iddle nam e(s)] : Nature of Business (if applicable): Fishing Farming Aquaculture Silviculture Other: M ailing Address: City/Tow n/Village: Province: Telephone: Cell: Postal Code: Fax: E-m ail: Section B – Refund Information 1. Marked Gasoline and/or Marked Diesel Oil Perm it No. 2. Period of Claim (dates) 20 to 20 3. Com plete schedule on reverse and attach all original receipts . 4. Brief description of the reason for requesting the refund. Attach a separate sheet if required. 5. List all vehicles and equipm ent that were refueled from the purchases listed on reverse. Attach a separate sheet if required. Section C – Refund Requested Total product purchased: litres Total product on which refund is requested: litres @ per litre = $ Section D - Certification I certify that the information herein is accurate and complete. I understand that it is an offence, subject to prosecution under the Revenue Administration Act, to make any false statement(s) on this application. I authorize any inspector under the Revenue Administration Act or any peace officer to inspect my books and records, vehicles or premises and to open any storage tank and remove therefrom any quantity of gasoline or diesel oil sufficient in their opinion, for the purposes of determining whether there has been compliance with the Gasoline Tax Act. Name (please print) Title Signature Date December 2011 Telephone 11PT15-30638 Next Page ? Previous Page NOTE: You can fill out these fields for printing, but cannot save the values here Below, list all purchases (by date) of product and attach all original invoices. (Attach a separate sheet if required.) Date Name of Supplier Invoice Number Total Taxed Product Purchased (enter in Section C on reverse) For Office Use Only Application status: Signature: Com m ents: Approved Q Denied Q Client Access No. : Taxed Litres __________________