FORM     MARYLAND   REFUND CLAIM FORM
                         MOTOR FUEL
                706      TAX

This claim is subject to audit and possible adjustment. This fuel may be                            DO NOT WRITE IN SHADED AREAS
subject to sales and use tax. See instructions on page 2.
                                                                                   Class ______________________    Refund Status _________________
FEIN Number
                                                                                   County Code ________________   Tran Status ___________________
SSN Number                                                                         Account Number ____________________________________________
Name (1)                                                                           Sequence Number ___________________________________________

Name (2)                                                                           Type of Refund (Check one): 
Address (1)                                                                             Farm
Address (2)                                                                             Construction
City, State, ZIP                                                                        Boat (Commercial purpose only)
Telephone Number                                                                        Aircraft (Specify reason for exempt qualification) _______________
                                                                                        ______________________________________________________
E-Mail Address
                                                                                        Other: ________________________________________________
                                                                                   Period of Claim
                                                                                        From ______________________     To ______________________

Period of Fuel Purchase            Column A                                                                            Tax 
  From _______________             Enter Gallons              Column B                        Column C                 Per
                                   Purchased Each Period      Enter Non-Refundable            Net Refundable           Gallon
                                   (Use rounded               Gallons (Use rounded          Gallons (Use rounded       (See          Column D
      To _______________ Fuel Type numbers)              LESS numbers)             EQUALS     numbers)           TIMES Chart) EQUALS Refund Amount
                         GAS                             –                         =                             X               =
                         GAS                             –                         =                             X               =
                         GAS                             –                         =                             X               =
                         DIESEL                          –                         =                             X               =
                         DIESEL                          –                         =                             X               =
                         AVIATION                        –                         =                             X     .07       =
                         TOTALS                          –                         =

CERTIFICATION: Under penalties of perjury, I declare that I have examined this return, and I hereby certify that all statements herein made are true to the best of my knowledge 
and belief, and that no part of the refund herein claimed has been heretofore paid. I further certify that the tax for which I am claiming a refund has been paid by me to the seller.

                 Signed: ____________________________________________________________________     Date: ________________________

                 Printed Name: ________________________________________________     Title: _______________________________________
706   (Rev01/24)

FORM           MARYLAND     REFUND CLAIM FORM 
706   MOTOR FUEL            INSTRUCTIONS
                 TAX

IMPORTANT:  Your claim cannot be accepted unless it           § 13-1030. False or fraudulent claims for refunds of
is prepared in accordance with the instructions listed        motor fuel tax.
below.
                                                              (a) False  claims: A  person  who makes  or  assists
1.  The  total gallons  of  fuel  purchased  in Maryland,         another  person  to make  a  false  claim for  refund  of
    supported  by  the  original invoice for  each  purchase,     motor  fuel tax  is guilty of  a  misdemeanor  and,  on
    must  be entered in column A  corresponding  to the           conviction, is subject to a fine not exceeding $1,000
    period when the fuel was purchased (see invoice date).        and imprisonment in the county jail not exceeding six
2.  Column A must always equal the sum of column B and            months or both.
    column C for each line.                                   (b) Fraudulent  Claims:  A  person  who  fraudulently
3.  Multiply the amount in column C of each line by the           obtains  or  assists  another  person  to  fraudulently
    applicable tax per gallon. Enter this amount in column        obtain  a  refund  of  motor  fuel tax  is guilty  of  a
    D for each line.                                              misdemeanor and, on conviction, is subject to a fine
                                                                  not exceeding $1,000 or imprisonment in the county
                                                                  jail not exceeding six months or both.
               Effective Dates Type Rate
      7/1/2015 - 12/31/2015    GAS  .321                      For more information
      7/1/2015 - 12/31/2015    DSL  .3285                     Visit our Web site at marylandtaxes.gov or call Taxpayer 
                                                              Service at 1-800-638-2937 or 410-260-7980 from Central
      1/1/2016 - 6/30/2016     GAS  .3260                     Maryland. For the hearing impaired: Maryland Relay Service 
      1/1/2016 - 6/30/2016     DSL  .3335                     711.

      7/1/2016 - 6/30/2017     GAS  .3350                     Comptroller of Maryland
      7/1/2016 - 6/30/2017     DSL  .3425                     Revenue Administration Division
      7/1/2017 - 6/30/2018     GAS  .3380                     Motor Fuel Refund Unit Room 306B
                                                              110 Carroll Street
      7/1/2017 - 6/30/2018     DSL  .3455                     Annapolis, MD 21411-0001
      7/1/2018 – 6/30/2019     GAS  .353
      7/1/2018 – 6/30/2019     DSL  .3605
      7/1/2019 – 6/30/2020     GAS  .3670
      7/1/2019 – 6/30/2020     DSL  .3745
      7/1/2020 – 6/30/2021     GAS  .3630
      7/1/2020 – 6/30/2021     DSL  .3705
      7/1/2021 – 6/30/2022     GAS  .3610
      7/1/2021 – 6/30/2022     DSL  .3685
      7/1/2022 – 6/30/2023     GAS  .4270
      7/1/2022 – 6/30/2023     DSL  .4345
      7/1/2023 - Present       GAS  .4700
      7/1/2023 - Present       DSL  .4775

4.  Add the sum totals of columns A, B, C and D and enter
    on the TOTALS line.
5.  The sum total of column D will equal your refund.

Provisions of Law Pertaining to Refunds Tax General-
Article, Title 13
§ 13-1029. Violation of motor fuel tax provisions.
A person who violates any provision of Title 9, Subtitle 3 of
this article is guilty of a misdemeanor and, on conviction,
is subject to a fine not exceeding $1,000 or imprisonment
in the county jail not exceeding six months or both.

706 (Rev 01/24)