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Form R11 Government North Dakota Office of State Tax Commissioner Motor Vehicle Fuel Tax Claim For Refund 2011 Federal Employer Identification Number Please Read Instructions Before Completing Form

All claims must have been filed within one year after the date you first used the gasohol in a commercial motor vehicle. You may qualify for a tax credit. If you are claiming a tax credit for: A small-unit lease, you must show you are leasing the leased vehicle from the owner. In order to qualify for this deduction, you must fill out a Claim for Refund form and submit to: Federal Tax Collector's Office-Motor Vehicle Fuel Tax Claim for Refund. Office of State Tax Commissioner-Motor Vehicle Fuel Tax Claim for Refund Note: Your vehicle must be leased from the owner. Claim for Refund can be completed by any person, including a business. If your vehicle is not leased, you must complete the form and attach evidence of the claim to your tax records. If you are leasing your vehicle from the owner, claim in the following format: The owner's mailing address is the address on your lease agreement or lease agreement documents (such as bill of lading). If you do not know the owner's mailing address, you must provide an address that you believe reflects the owner's address. Do not include a “s” in the owner's name, that will appear in the claim as a mark or error and may delay processing of your claim. If the address you provide is inaccurate, you may file a completed and signed form at the appropriate address on our website:. Your vehicle lease must have been signed within one year after the date you first used gasoline or fuel in construction, reconstruction, or maintenance of roads or highways or other maintenance purposes, or the date your registration expires. You cannot include in the fuel tax claim any amount more or less than five per cent of the gross weight of the leased vehicle used in construction, reconstruction, or maintenance of roads or highways or other maintenance purposes. You cannot include any amount paid to the leasing agent for the lease of the leased vehicle. The leasing agent must have obtained a written acknowledgment from you confirming that you are leasing, but not more than three years after the date your registration expires, your vehicle is not a motor vehicle of municipal origin, and you have not paid any other taxes due on the leased vehicle.

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