Departmentof TaxationandFinance

                        Alternative Tax Rate                                                                                               IFTA-115(3/21)
                        Claim for Fuel Use Tax Refund
                        ForfuelpurchasedonandafterJanuary1,1996
                        Tax Law – Article 21-A

Employeridentificationnumber(andsuffix,if                  SocialSecuritynumber(ifnoEIN)   Mailto:
                                                                                                   NYS TAX DEPARTMENT
Nameofcarrier                                                                                      TDAB/IFTA
                                                                                                   W A HARRIMAN CAMPUS
Streetaddress                                                                                      ALBANY NY 12227-2991

                                                                                         ZIP IFTA  basejurisdiction

Computation of refund
  A            B                                    C      D                             E                                                     F
  Quarterly    Fuel     NetNew Yorktaxablegallons          NewYorktaxrate                AlternativeNew York                               Netrefundclaimed
  period       type                     (from IFTA report) (from IFTA report)            taxrate                                           C × (D - E)
  (month/year)

Total refund claimed (add column F amounts)  ..............................................................................................

Certification.Icertifythatthisrefundclaimandanyattachmentsaretothebestofmyknowledgeandbelieftrue,correct,andcomplete.
               Signatureofauthorized                         Officialtitle
  Authorized
  person       Emailaddressofauthorized                                                                                                    Date

  Paid       Firm’sname (or yours if self-employed)                       Firm’s                             Preparer’sPTINorSSN
 preparer    Signatureofindividualpreparingthis                                                                                            ZIP  code
  use
  only       Emailaddressofindividualpreparingthis           Preparer’s                            Date
 (see instr.)                                                                                      excl.code  

Page 2of2  IFTA-115(3/21)

                                                       Instructions
General information                                        componentsforafilingperiod,callthe TaxDepartmentatthe
UsethisformonlyifyouhaveanInternationalFuel     Tax        numberlistedinthe      Need Help?boxbelow.
Agreement(IFTA)license.
                                                           Paid preparer’s responsibilities
Youmayusethisformtoclaimarefundofthedifference             Underthelaw,allpaidpreparersmustsignandcompletethe
betweentheNew YorkfuelusetaxthatyoupaidonyourIFTA          paidpreparersectionoftheform.Paidpreparersmaybesubject
reportandtheamountofNew     Yorkfuelusetaxthatisdue        tociviland/orcriminalsanctionsiftheyfailtocompletethis
basedonyourowncomputationofthesalestaxcomponent            sectioninfull.
includedinthetaxrate.  Youmustmakeaseparatecomputation
foreachfueltypeandeachperiod.                              Whencompletingthissection,enteryourNew    Yorktaxpreparer
                                                           registrationidentificationnumber(NYTPRIN)ifyouarerequired
Youmustmaintainrecordsofallfuelpurchasestoproveyour        tohaveone.IfyouarenotrequiredtohaveaNYTPRIN,enter
actualaveragepricepergallonoffuelusedinyourcomputation     intheNYTPRINexcl. code boxoneofthespecified2-digit
ofthesalestaxcomponent.Evidenceofthefuelpurchasemust       codeslistedbelowthatindicateswhyyouareexemptfromthe
beintheformofpurchaseinvoicesordeliverytickets.            registrationrequirement. YoumustenteraNYTPRINoran
Donotsubmitpurchaseinvoicesorotherrelatedrecordswith       exclusioncode. Also,youmustenteryourfederalpreparertax
yourclaimforrefund.However,youmayberequiredtosubmit        identificationnumber(PTIN)ifyouhaveone;ifnot,youmust
theserecordsuponrequest. Youmustkeeptheoriginalinvoices    enteryourSSN.
andotherrecordsforaminimumoffouryears.
                                                           Code Exemption type           Code Exemption type
Yourclaimforrefundmustbefiledwithin49monthsfollowing
theendofthereportingperiodforwhichyouareclaiminga          01      Attorney              02 Employeeofattorney
refund.                                                    03      CPA                   04 EmployeeofCPA
Attach a copy of the IFTA report for each reporting period 05      PA(Public Accountant) 06 EmployeeofPA
for which you are claiming a refund.                       07      Enrolledagent         08 Employeeofenrolledagent
                                                           09      Volunteertaxpreparer  10 Employeeofbusiness
Computation of refund                                                                       preparingthatbusiness’ return
Column A –Enterthequarterlyperiod(month/year)forwhich
youareclaimingarefund.                                                           NewYorkStateLawrequiresall
                                                           Privacy notification – 
Column B –Enterthefueltype.   Youmustmakeaseparate         governmentagenciesthatmaintainasystemofrecordsto
computationforeachfueltypeforeachperiod.                   providenotificationofthelegalauthorityforanyrequestfor
                                                           personalinformation,theprincipalpurpose(s)forwhichthe
Column C –EnterthenetNew      Yorktaxablegallons(asshown   informationistobecollected,andwhereitwillbemaintained.
onyourIFTA report)forthefueltypeenteredincolumnB.          Toviewthisinformation,visitourwebsite,or,ifyoudonot
Column D –EntertheNew    Yorktaxrate(asshownonyour         haveInternetaccess,callandrequestPublication54,       Privacy 
IFTAreport)forthefueltypeenteredincolumnB.                 Notification.SeeNeed help?    fortheWebaddressandtelephone
                                                           number.
Column E –EnteryouralternativeNew      Yorktaxratebasedon
yourcomputationofthesalestaxcomponentincludedinthetax
rate.                                                      Need help?

Calculating alternative rates                                            Visitourwebsiteat  www.tax.ny.gov
Ifyoumaintainsubstantiatingrecords,youmaycomputethe                      getinformationandmanageyourtaxesonline
salestaxcomponentsfordieselandothermotorfuelsbasedon
youractualaveragepricepergallonofthesefuelsusedduring                    checkfornewonlineservicesandfeatures
thereportingperiod,insteadofusingtheprevailingpriceper
gallonestablishedbythe TaxDepartmenttocomputethesales      Telephone assistance
taxcomponentincludedintheNewYorktaxratesshownonyour        MiscellaneousTaxInformation                     518-457-5735
IFTAreport. Tocomputethealternativesalestaxcomponents
separatelyfordieselandothermotorfuels:                     Toorderformsand                                 518-457-5431
1.Determinethetotalcostoffuelpurchasedthatisusedduring     TextTelephone(TTY)or                      Dial7-1-1forthe       
thequarter,includingfederal,stateandlocaltaxes,butnot      equipmentusers                     NewYorkRelayService
includingstateorlocalsalestaxesoranyothertaxesupon
whichstateandanylocalsalestaxisnotcomputed.For
example,inNew YorkStatethedieselmotorfueltaxandthe
motorfueltaxarenotincludedinthetotalcostoffuel.
2.Dividethisamountbythetotalnumberofgallonsoffuelused
(bothinandoutsideNew     York)toarriveattheaverageprice
pergallon.
3.Computeyoursalestaxcomponentbymultiplyingthe
averagepricepergallonby7%(roundtothenearesttenthof
acent;thatis,.08753=.088).
4.SubtractthesalestaxcomponentincludedintheNew        York
taxrateshownonyourIFTA      report,andaddthesalestax
componentthatyoucomputed.     Togetthetaxratesand