
Form AU-738 Back (Rev. 09/04)
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
Instructions
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.
Table of Motor Vehicle Fuels Tax Refund Rates for 2004
for Nutrition Program
Diesel January 1, 2004 through December 31, 2004 26¢ per Gallon
Motor Vehicle Fuels
January 1, 2004 through December 31, 2004 25¢ per Gallon
Note: You must file a separate Form AU-738 for each motor
vehicle fuel type.