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GASOLINE TAX REFUND CLAIM FORM SCGR-1 Rev. Dec. 2012 Reset State of California Print Send completed forms to Address Change For SCO Use Only Contact Information Phone 916 322-9695 Fax 916 327-7116 E-mail gtr sco. ca.gov Public Website www. sco. ca.gov California State Controller Tax Administration Section P. O. Box 942850 Sacramento CA 94250-5880 First-Time Claimant Claim No./Received Date Renewal Claimant SCO Account No. Name of Claimant Mailing Address Location of Operation Federal Tax...
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Date/Time Claimant First-Time Claimant Subsequent-Time Claimant 2. Filing Agency Name (if different from address below) California Department of Tax and Fee Enforcement Mailing Address California Department of Tax and Fee Enforcement P.O. Box 91450 Sacramento, CA 95 Statewide Service Center: P.O. Box 942850 Sacramento, CA 94 Service Center: 3. Description of Property Owner (if owner is other than owner of property for sale or use/renewal) Business Name Business Address City, State or Zip (State or Zip) Date / Time Property Owner's Address Change Property Name Subsequent-Time Property Owner's Address Change. Please note that the date/time information is for the original state tax year/year and year. If the new owner takes possession of the property after the date/time, then the new owner may have a different date/time. Additionally, California law allows two different dates/times for a property change from the date/time shown above. Please contact your business tax advisor to find out how to adjust these dates/times. 4. Claim Description. (Note that the claim description below is an approximation based on this tax year's information.) (This claim shows the following information about your property's status if you file your claim: The date/time the property was rented out as of the date you filed your claim, The date/time when the property was first used as an occupant as of the date/time you filed your claim, The date/time the property was rented out from January 1st to December 31st of the current year and the date/time the property was rented out from January 1st to December 31st of the previous year. You can determine the date/time the property owner is changing ownership or use as follows: 1. Determine when the new property owner moved into the area. Contact your legal advisors for information if the new owner moved in before or after the filing date/time of the claim. 2. Determine the specific location of the property before and after the date/time of the claim. 3.

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