New York State Department of Taxation and Finance
                                                                                                                   FT‑500‑I
                      Instructions for Form FT‑500                                                                                           (9/11)
                      Application for Refund of Sales Tax Paid on Petroleum Products
Who may use this form                                                    C — Farm production or commercial horse boarding 
A  Exempt organizations (except for New York State (NYS)                 operations — Motor fuel and diesel motor fuel used or consumed 
   government entities)                                                  in farm production or in a commercial horse boarding operation, or 
                                                                         in both.
B  Qualified Indian nations or tribes
C  Farmers or commercial horse boarding operators                        Attach a statement describing in detail the manner in which the 
                                                                         motor fuel or diesel motor fuel was used. 
D  Qualified empire zone enterprises (QEZE) who use the fuel 
   in qualifying motor vehicles or who use the fuel directly and         Farming includes:
   predominantly (at least 50%) in empire zones where they have          • agriculture, floriculture, horticulture, viniculture, viticulture,
   qualified to receive benefits                                           aquaculture and silviculture
E  Omnibus carriers or vessel operators providing local transit          • stock, dairy, poultry, fruit or vegetable, furbearing animals,
   service within NYS                                                      graping, truck and tree farming
F  Purchasers of fuel used for residential heating                       • ranching
G  Indians who are enrolled members of an exempt tribe or nation,        • operating nurseries, greenhouses, vineyard trellises or other
   and who took delivery of the motor fuel or diesel motor fuel on a       similar structures used primarily for the raising of agricultural,
   qualified reservation for their use                                     floricultural, horticultural, vinicultural, viticultural or silvicultural
H  Manufacturers, processors, generators, assemblers, refiners,            commodities
   miners, and extractors                                                • operating orchards
I  Other purchase exempt pursuant to Tax Law Section 1115(a)             • raising, growing, and harvesting crops, livestock and livestock
Note: This form may not be used to claim a refund of the prepaid           products, and raising, growing, and harvesting woodland
sales tax. See Form FT-949, Application for Refund of Prepaid              products, including, but not limited to, timber, logs, lumber,
Sales Tax on Motor Fuel Sold Other Than at Retail Service Stations,        pulpwood, posts and firewood
FT-950, Application for Refund of Prepaid Sales Tax on Motor Fuel        A commercial horse boarding operation is:
Sold at Retail Service Stations  , FT-1007, Application for Refund 
of Prepaid Sales Tax on Highway Diesel Motor Fuel Sold at Retail         • an agricultural enterprise consisting of at least 7 acres and
Service Stations, FT-1010, Application for Refund of Prepaid Sales         boarding at least 10 horses, regardless of ownership, that
Tax on Diesel Motor Fuel Sold Other Than at Retail Service Stations  ,     receives $10,000 or more in gross receipts annually from fees
or Schedule FR of your sales tax return for details.                       generated either through the boarding of horses or through the
                                                                           production for sale of crops, livestock, and livestock products, or
                                                                           through both such boarding and such production.
Line Instructions
Line 2 — Enter the beginning and ending dates of the period for          Note: A commercial horse boarding operation does not include 
which this application is being made in the format shown. The            operations whose primary on-site function is horse racing. 
period covered by the claim should be at least one month, but can        D — Qualified Empire Zone Enterprise (QEZE) — You may apply 
include more than one month. The beginning date should be the            for a refund of sales tax paid on qualifying fuel purchases if you are 
first day of a month and the ending date should be the last day of       a QEZE for sales and use tax purposes and you meet the criteria 
the month. If your claim is based on a QEZE exemption, a refund          below.
may only be filed once each sales tax quarter.
                                                                         If you were certified by Empire State Development (ESD) before 
Line 8                                                                   April 1, 2009, you must have:
A — Exempt organizations — Organizations include religious,              • applied for and received Form DTF-81, Qualified Empire
charitable, scientific, and educational institutions that have qualified   Zone Enterprise (QEZE) Sales Tax Certification, from the Tax
for exempt status under NYS sales tax law; certain posts or                Department;
organizations consisting of past or present members of the armed         • received your Empire Zone Retention Certificate (EZRC) from
forces of the U.S.; and certain credit unions. See Publication 843, A      ESD; and
Guide to Sales Tax in New York State for Exempt Organizations, for       • passed the employment test for the tax year ending before the
more information.                                                          period covered by this claim.
A NYS government entity may claim a refund by filing Form FT-504,        If you meet these qualifications, you may use this form to claim a 
Claim for Refund of Taxes Paid on Fuel by a Government Entity.           refund for tax paid on qualifying fuel purchases.
If you marked A, by an exempt organization, you must enter the           If you were certified by ESD on or after April 1, 2009, you must 
exempt organization number. You must also attach a copy of               have:
Form ST-119, Exempt Organization Certificate, to this application.
                                                                         • received your EZRC from ESD; and
B — Qualified Indian nations or tribes — Only the Indian nations         • passed the employment test for the tax year ending before the
and tribes identified below are eligible for a refund of sales tax paid    period covered by this claim.
on their purchases of motor fuel and diesel motor fuel.
• Cayuga                         • Seneca Nation of Indians              If you meet these qualifications, you may use this form to claim 
• Oneida Indian Nation           • Shinnecock                            a refund for tax paid on qualifying fuel purchases, but only if the 
• Onondaga Nation of Indians     •  Tonawanda Band of Senecas            qualifying purchase is made in a locality that has elected to provide 
• Poospatuck                     • Tuscarora Nation of Indians           the refund. For more information, see Publication 718-QZ, Qualified 
• St. Regis Mohawk                                                       Empire Zone Enterprise (QEZE) Sales and Use Tax Refund Rates, 
                                                                         and TSB-M-09(12)S, Changes to Qualified Empire Zone Enterprise 
To qualify, the nation or tribe must have applied for and received       (QEZE) Program (Articles 28 and 29) - Effective September 1, 2009. 
a 6-digit exempt organization number from the Tax Department             You must pass an employment test at the end of every tax year 
(Form ST-119). If you marked B, by a qualified Indian nation or tribe,   (calendar or fiscal) to determine if you qualify for QEZE sales 
you must enter the exempt organization number. You must also             tax benefits for the next tax year. The effective date from your 
attach a copy of Form ST-119 to this application.

Page 2 of 4  FT-500-I (9/11)

Certificate of Eligibility (issued by ESD) determines which worksheet   • invoices, receipts, proof of payment of tax, etc.
you need to include.
                                                                        E — Omnibus carrier or vessel operator — Omnibus carrier 
• Form AU-12.1, Employment Test for Businesses Certified by             and vessel operators who provide local transit service in NYS 
Empire State Development (ESD) Before April 1, 2005                     and operate pursuant to a certificate of public convenience and 
• Form AU-12.2, Employment Test for Businesses Certified by             necessity issued by the NYS Commissioner of Transportation or 
Empire State Development (ESD) On or After April 1, 2005, and           by a like officer or agent of the U.S., or pursuant to a contract or 
Before April 1, 2009                                                    agreement with New York City (NYC). An omnibus is a motor vehicle 
• Form AU-12.3, Employment Test for Businesses Certified by             with a seating capacity of more than seven passengers used for 
Empire State Development (ESD) On or After April 1, 2009                the transportation of passengers for hire. A vessel is any type of 
                                                                        watercraft with a seating capacity of more than 20 passengers that 
If you were certified before April 1, 2009, complete the                is used for the transportation on water of passengers for hire. 
employment test using your base period information from your 
application for QEZE sales tax certification filed with the Tax         The refund applies to sales and use tax paid on fuel purchased 
Department (Form DTF-80, Application for a Qualified Empire             and used in the operation of a qualifying omnibus or vessel. The 
Zone Enterprise (QEZE )Sales Tax Certification; Form DTF-82,            refund is based on thelocal transit service percentage, which 
Application for a Qualified Empire Zone Enterprise (QEZE) Sales         is the proportion that an omnibus carrier’s vehicle mileage or a 
Tax Certification — For businesses certified by Empire State            vessel operator’s vessel hours operated in local transit service in 
Development before August 1, 2002; Form DTF-83, Application for         NYS in the calendar year immediately preceding the end of the 
a Qualified Empire Zone Enterprise (QEZE) Sales Tax Certification —     quarterly return period to which such refund relates bears to the 
For businesses certified by Empire State Development on or              total omnibus carrier’s vehicle mileage or the vessel operator’s 
after August 1, 2002, and before April 1, 2005; or Form DTF-84,         total vessel hours operated in NYS in such year. The amount of the 
Application for a Qualified Empire Zone Enterprise (QEZE) Sales         refund is determined by multiplying the sales or use tax paid by the 
Tax Certification — For businesses certified by Empire State            omnibus carrier or vessel operator on its purchases of fuel during 
Development on or after April 1, 2005, and before April 1, 2009).       the quarter by the operator’s local transit service percentage. If the 
                                                                        omnibus carrier or vessel operator was not engaged in local transit 
If you have more than one empire zone (EZ) location, use the            service in the prior calendar year, it would determine its local transit 
effective date from your first (earliest) Certificate of Eligibility to service percentage with respect to its first four quarterly sales tax 
determine which worksheet you need to file.                             returns by using the proportion that the omnibus carrier’s vehicle 
                                                                        mileage operated or the vessel operator’s vessel hours in local 
You must complete and pass the employment test using your               transit service in NYS in the first three months of operation bears 
employment numbers for the tax year ending before the period            to the omnibus carrier’s total mileage or the vessel operator’s total 
covered by this application to qualify for the refund being claimed.    hours operated in NYS in those three months.
Once you have completed the employment test worksheet for a tax 
year, attach a copy of that worksheet to any subsequent claim for 
refund to which that employment test applies.                            If the local transit service The refund or credit is:
                                                                         percentage is:
If your refund claim covers periods from more than one tax year, 
you must complete and attach employment test worksheets for              Less than 10%                None
each tax year required.                                                  10%                          10% of the combined 
                                                                                                      state and local taxes paid 
To qualify, the fuel must be used or consumed predominantly in an 
EZ where the QEZE has qualified for benefits; or the fuel must be        Greater than 10%,            10% plus the product of 1.5 times 
used in a qualifying motor vehicle. For purposes of the refund, a        but less than 70%            each whole percent of excess 
QEZE’s use of a motor vehicle or property related to a motor vehicle                                  of 10% of the combined state and
will be found to occur predominantly in an EZ where the QEZE has                                      local taxes paid  
qualified for benefits if:                                               70% or more                  100% of the combined
• the QEZE uses the vehicle at least 50% exclusively in such a                                        state and local taxes paid 
zone; or
• at least 50% of the vehicle’s use is in activities originating or     Local transit service — For omnibuses, local transit service means 
terminating in such a zone; or                                          a mass transit service (as distinguished from a charter, contract, 
• at least 50% of its use is a combination of use exclusively in such   school bus, sightseeing, or other service) provided by an omnibus 
a zone and in activities originating or terminating in such a zone.     carrier in which passengers are carried by omnibuses from one 
                                                                        point in NYS to another point in NYS and in performance of which 
The QEZE may choose to compute the usage of the vehicle based           the omnibuses either:
on either hours of use or miles traveled. A refund claim may be 
filed only once each sales tax quarter. See Publication 718-QZ to       • regularly pick up or discharge passengers at their convenience
determine whether you can apply for a refund of the state tax only,     or at bus stops on the street or highway, as distinguished from
or if you are entitled to a refund of the state and local tax.          buildings or facilities used for bus terminals or stations; or
                                                                        • pick up and discharge passengers at bus terminals or stations,
You must attach all required substantiation and documentation or        the distance between which is not more than 75 miles, measured
your claim will not be processed. This includes:                        along the route traveled by the bus.
• copy of the Certificate of Eligibility issued by ESD;
                                                                        Vehicle mileage — Vehicle mileage means the number of miles 
• copy of the EZRC issued by ESD;                                       run by all omnibuses operated by a carrier in the performance of 
• employment test worksheet:                                            local transit service plus the number of idle miles run to the point 
— Form AU-12.1, if you were certified by ESD before April 1,            at which service begins and from the point at which such service 
    2005                                                                terminates. Such mileage includes only miles operated within NYS.
— Form AU-12.2, if you were certified by ESD on or after                Total mileage operated — Total mileage operated includes the 
    April 1, 2005, and before April 1, 2009                             vehicle mileage plus the number of miles operated in charter 
— Form AU-12.3, if you were certified by ESD on or after                service, school contract service, other contract service, excursion 
    April 1, 2009                                                       service, sight-seeing service, and all other passenger service which 
• documentation regarding the manner in which the motor fuel or         is not included within the meaning of vehicle mileage. Such mileage 
diesel fuel was used;                                                   includes only miles operated within NYS.

                                                                                                        FT-500-I (9/11)       Page 3 of 4

For vessels, local transit service means a mass transit service (as   Qualified reservations:
distinguished from a charter, contract, excursion, sightseeing or     • Allegany                   • Poospatuck
other passenger service) provided by a vessel operator in which       • Cattaraugus                • St. Regis Mohawk (Akwesasne)
passengers are carried by a vessel operator from one point in NYS     • Oil Spring                 • Shinnecock
to another point in NYS and in performance of which the vessels:      • Oneida                     • Tonawanda
(a)  regularly pick up and discharge such passengers as scheduled,    • Onondaga                   • Tuscarora
 or at their convenience, at designated piers, slips, docks, or 
 other landings along waterways, as distinguished from buildings      If you marked G, by a qualified Indian, you must enter the tribe or 
 or similar facilities used as terminals or stations; or              nation and the qualifying reservation the fuel was delivered to. 
(b) pick up and discharge passengers at terminals or stations, the    H — Manufacturers, processors, generators, assemblers, 
 distance between which is not more than 75 miles, measured           refiners, miners, and extractors — Motor fuel (such as gasoline 
 along the route traveled by the vessels; or                          or liquefied petroleum gas) and diesel motor fuel (highway or 
(c) picks up and discharges passengers as described in both (a)       non-highway fuel) purchased for use directly and exclusively in 
 and (b).                                                             the production of tangible personal property for sale are eligible 
                                                                      for a refund of NYS and local sales tax. Purchases of motor fuel or 
Vessel hours — Vessel hours means the number of hours that all        diesel motor fuel used or consumed directly and exclusively in the 
vessels are operated by a vessel operator in the performance of       production of gas, electricity, refrigeration, and steam for sale are 
local transit service, plus the number of idle hours used to reach    also eligible for a refund from NYS and local sales tax except for 
the point at which such service begins and from the point at which    the local tax imposed on sales and uses in NYC; however, the NYS 
such service terminates. Such hours include only those hours          portion of sales tax remains eligible for refund.
operated in NYS.
Total hours operated — Total hours operated means the vessel          Schedule of motor fuel and diesel motor fuel purchases
hours computed as described above (see Vessel hours), plus the        You must submit copies of all invoices on which the claim is based. 
number of hours used in charter, contract, excursion, sight-seeing,   Invoices must be in the name of the claimant and show the amount 
and all other passenger service, which hours are not included in the  of tax paid by the claimant. Receipts that do not identify the 
meaning of vessel hours. Such hours include only hours operated       claimant as the purchaser are not acceptable.
in NYS.                                                               If you need more space, attach additional sheets displaying the 
If you marked box D, by an omnibus or vessel operator in local        information in the same format as the form. Enter the total of the 
transit service, you must attach a copy of your local transit service sales tax refund claimed on the additional sheets on the appropriate 
percentage computation.                                               line.
F — Residential purposes — Fuel used for residential purposes 
is exempt from NYS sales tax, but is subject to local tax in some     Signature
areas.                                                                The application must be signed and dated by the owner (if an 
                                                                      individual), a partner (if a partnership), or by the president, treasurer, 
The Tax Law provides that residential energy sources and services     chief accounting officer, or any other person authorized to act on 
are not subject to the 4% NYS sales and use tax rate and the          behalf of the corporation (if a corporation).
⅜% sales tax rate imposed within the MCTD. Counties and cities 
that impose a local sales and use tax may choose to either tax or     The fact that an individual’s name is signed on the certification will 
exempt residential energy sources and services. If you purchased      be prima facie evidence that the individual is authorized to sign and 
motor fuel or diesel motor fuel on which you paid full NYS and        certify the report on behalf of the applicant.
local sales tax and this fuel was used for residential purposes, you  Additionally, if anyone other than an employee, owner, partner, or 
are entitled to a refund of the NYS, and possibly the local, sales    officer of the applicant is paid to prepare the application, he or she 
tax. See Publication 718-R, Local Sales and Use Tax Rates On          is required to sign and date the application and provide his or her 
Residential Energy Sources and Services, for a listing of the local   mailing address.
tax rates in effect on residential energy sources and services.
Attach a statement specifying the exemption claimed and describe      Paid preparer identification numbers
in detail the manner in which the motor fuel or diesel motor fuel was New York State Tax Law requires certain paid tax return preparers 
used.                                                                 and facilitators of refund anticipation loans (RALs) and refund 
                                                                      anticipation checks (RACs) to register electronically with the Tax 
G — Qualified Indian — For a qualified Indian to obtain a refund,     Department. When completing this section, you must enter your 
he/she must be:                                                       New York tax preparer registration identification number (NYTPRIN) 
• the direct purchaser and payer of record;                           if you are required to have one. (Information on the New York State 
• an enrolled member of one of the exempt nations or tribes listed    Tax Preparer Registration Program is available on our Web site. See 
 below;                                                               Need help?) In addition, you must enter your federal preparer tax 
                                                                      identification number (PTIN) if you have one; if not, you must enter 
• purchasing the motor fuel, diesel motor fuel, or heating oil for    your social security number (SSN). (PTIN information is available at 
 personal use and not for resale  ; and                               www.irs.gov.)
• taking delivery of the fuel on one of the qualified reservations
 listed below.                                                        When to file
There is no refund for tax paid on fuel purchased or delivered to the You must file the application for refund within three years from the 
qualified Indian off the reservation.                                 date the tax was payable to the Tax Department.
Only members of the following Indian nations and tribes in NYS are 
entitled to a sales tax refund:                                       Where to file
                                                                      Mail refund applications to: NYS TAX DEPARTMENT
• Cayuga                          • Seneca Nation of Indians                                       FUEL TAX REFUND UNIT 
• Oneida Indian Nation            • Shinnecock                                                     PO BOX 5501
• Onondaga Nation of Indians      •  Tonawanda Band of Senecas                                     ALBANY NY 12205‑ 5010
• Poospatuck                      • Tuscarora Nation of Indians
• St. Regis Mohawk

Page 4 of 4  FT-500-I (9/11)

Private delivery services
If you choose, you may use a private delivery service, instead of 
the U.S. Postal Service, to mail in your form and tax payment. 
However, if, at a later date, you need to establish the date you 
filed or paid your tax, you cannot use the date recorded by a 
private delivery service unless you used a delivery service that 
has been designated by the U.S. Secretary of the Treasury or the 
Commissioner of Taxation and Finance. (Currently designated 
delivery services are listed in Publication 55, Designated Private 
Delivery Services. See Need help? below for information on 
obtaining forms and publications.) If you have used a designated 
private delivery service and need to establish the date you filed your 
form, contact that private delivery service for instructions on how to 
obtain written proof of the date your form was given to the delivery 
service for delivery. If you use any private delivery service, whether 
it is a designated service or not, send the forms covered by these 
instructions to the appropriate address listed in Publication 55. 

Privacy notification
The Commissioner of Taxation and Finance may collect and 
maintain personal information pursuant 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 social security numbers pursuant to 
42 USC 405(c)(2)(C)(i).
This information will be used to determine and administer tax 
liabilities and, when authorized by law, for certain tax offset and 
exchange of tax information programs as well as for any other 
lawful purpose.
Information concerning quarterly wages paid to employees is 
provided to certain state agencies for purposes of fraud prevention, 
support enforcement, evaluation of the effectiveness of certain 
employment and training programs and other purposes authorized 
by law.
Failure to provide the required information may subject you to civil 
or criminal penalties, or both, under the Tax Law.
This information is maintained by the Manager of Document 
Management, NYS Tax Department, W A Harriman Campus, 
Albany NY 12227; telephone (518) 457-5181.

Need help?
       Visit our Web site at www.tax.ny.gov
       • get information and manage your taxes online
       • check for new online services and features
       Telephone assistance
Sales Tax Information Center:                     (518) 485-2889
To order forms and publications:                  (518) 457-5431
Text Telephone (TTY) Hotline (for persons with 
 hearing and speech disabilities using a TTY):  (518) 485-5082
       Persons with disabilities: In compliance with the 
       Americans with Disabilities Act, we will ensure that our 
       lobbies, offices, meeting rooms, and other facilities are
accessible to persons with disabilities. If you have questions 
about special accommodations for persons with disabilities, call the 
information center.