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                                                     Alternative Tax Rate                                                                 IFTA-115
                                                                                                                                                           (4/11)
                                  Claim for Fuel Use Tax Refund
                                  (for Fuel Purchased on and After January 1, 1996)
                                                                 Tax Law - Article 21-A
Type or print in ink.
 Employer identification number (and suffix, if any)                          Social security number (if no EIN)     Mail to:
                                                                                                                            NYS TAX DEPARTMENT
 Name of carrier                                                                                                            TDAB/IFTA
                                                                                                                            W A HARRIMAN CAMPUS
 Street address                                                                                                             ALBANY NY 12227

 City                                                State                                         ZIP code  IFTA base jurisdiction

                                                                 Computation of Refund
      A          B                                 C                            D                                 E                               F
  Quarterly      Fuel             Net New York taxable gallons                  New York tax rate  Alternative New York                   Net refund claimed
  period         type             (from IFTA report)                            (from IFTA report)                tax rate                C × (D - E)
(month/year)

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

Certification. I certify that this refund claim and any attachments are to the best of my knowledge and belief true, correct and complete.
 Signature of elected officer or authorized person             Official title                      Telephone number                       Date
                                                                                                   (   )
  Paid       Preparer’s signature                                Date           Preparer’s NYTPRIN                Preparer’s SSN or PTIN           Mark  
                                                                                                                                                   an  Xif
  preparer                                                                                                                                         self-employed
  use        Preparer’s firm name (or yours, if self-employed)   Firm’s EIN            E-mail                     
  only
 Address                                                                                                                                  Telephone number 
                                                                                                                                          (      )



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IFTA-115 (4/11) (back)
                                                          Instructions
General Information                                               4. Subtract the sales tax component included in the New York 
Use this form only if you have an International Fuel Tax          tax rate shown on your IFTA report, and add the sales tax 
Agreement (IFTA) license.                                         component that you computed. To get the tax rates and 
                                                                  components for a filing period, call the Tax Department at the 
You may use this form to claim a refund of the difference         number listed in the Need Help? box below.
between the New York fuel use tax that you paid on your IFTA 
report and the amount of New York fuel use tax that is due        Column F - Subtract column E from column D and multiply the 
based on your own computation of the sales tax component          result by the amount in column C.
included in the tax rate. You must make a separate computation 
for each fuel type and each period. This form may be used only    Paid preparer
for fuel purchased on and after January 1, 1996.                  If you pay someone to prepare Form IFTA-115, the paid 
                                                                  preparer must also sign it and fill in the other blanks in the paid 
You must maintain records of all fuel purchases to prove your     preparer’s area. If someone prepares Form IFTA-115 for you 
actual average price per gallon of fuel used in your computation  and does not charge you, that person should not sign it.
of the sales tax component. Evidence of the fuel purchase must 
be in the form of purchase invoices or delivery tickets.          Note to paid preparers — When signing Form IFTA-115, you 
                                                                  must enter your New York tax preparer registration identification 
Do not submit purchase invoices or other related records with     number (NYTPRIN) if you are required to have one. (Information 
your claim for refund. However, you may be required to submit     on the New York State Tax Preparer Registration Program is 
these records upon request. You must keep the original invoices   available on our Web site.) Also, you must enter your federal 
and other records for a minimum of four years.                    preparer tax identification number (PTIN) if you have one; if 
Your claim for refund must be filed within 49 months following    not, you must enter your social security number (SSN). (PTIN 
the end of the reporting period for which you are claiming a      information is available at www.irs.gov.)
refund.                                                           Privacy notification — The Commissioner of Taxation and 
Attach a copy of the IFTA report for each reporting period        Finance may collect and maintain personal information pursuant 
for which you are claiming a refund.                              to the New York State Tax Law, including but not limited to, 
                                                                  sections 5-a, 171, 171-a, 287, 308, 429, 475, 505, 697, 1096, 
                                                                  1142, and 1415 of that Law; and may require disclosure of 
Computation of Refund                                             social security numbers pursuant to 42 USC 405(c)(2)(C)(i).
Column A - Enter the quarterly period (month/year) for which 
you are claiming a refund.                                        This information will be used to determine and administer tax 
                                                                  liabilities and, when authorized by law, for certain tax offset and 
Column B - Enter the fuel type. You must make a separate          exchange of tax information programs as well as for any other 
computation for each fuel type for each period.                   lawful purpose.
Column C - Enter the net New York taxable gallons (as shown       Information concerning quarterly wages paid to employees 
on your IFTA report) for the fuel type entered in Column B.       is provided to certain state agencies for purposes of fraud 
Column D - Enter the New York tax rate (as shown on your IFTA     prevention, support enforcement, evaluation of the effectiveness 
report) for the fuel type entered in Column B.                    of certain employment and training programs and other 
                                                                  purposes authorized by law.
Column E - Enter your alternative New York tax rate based on 
your computation of the sales tax component included in the       Failure to provide the required information may subject you to 
tax rate.                                                         civil or criminal penalties, or both, under the Tax Law.
                                                                  This information is maintained by the Manager of Document 
Calculating Alternative Rates                                     Management, NYS Tax Department, W A Harriman Campus, 
If you maintain substantiating records, you may compute the       Albany NY 12227; telephone (518) 457-5181
sales tax components for diesel and other motor fuels based 
on your actual average price per gallon of these fuels used 
during the reporting period, instead of using the prevailing      Need help?
price per gallon established by the Tax Department to compute 
the sales tax component included in the New York tax rates 
shown on your IFTA report. To compute the alternative sales tax        Internet access: www.tax.ny.gov
components separately for diesel and other motor fuels:                  (for information, forms, and publications)
1. Determine the total cost of fuel purchased that is used during     Miscellaneous Tax Information Center: (518) 457-5735
the quarter, including federal, state and local taxes, but not 
including state or local sales taxes or any other taxes upon          To order forms and publications:      (518) 457-5431
which state and any local sales tax is not computed. For 
example, in New York State the diesel motor fuel tax and the          Text Telephone (TTY) Hotline
                                                                       (for persons with hearing and
motor fuel tax are not included in the total cost of fuel.              speech disabilities using a TTY):   (518) 485-5082
2. Divide this amount by the total number of gallons of fuel used 
(both in and outside New York) to arrive at the average price 
per gallon.
3. Compute your sales tax component by multiplying the 
average price per gallon by 7% (round to the nearest tenth of 
a cent; (e.g., .08753 = .088).






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