DO NOT WRITE IN SHADED AREAS

FORM        MARYLAND     REFUND CLAIM FORM
           MOTOR FUEL 
706                  TAX                                                         Class ______________________        Refund Status _______________

This claim is subject to audit and possible adjustment. This fuel may be         County Code ________________        Tran Status _________________
subject to sales and use tax. See instructions on page 2.
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                                                                                    Account Number                                    Sequence Number
SSN / IRS Number
Name (1)                                                                         Type of Refund (Check one): 
                                                                                   Farm
Name (2)
                                                                                   Construction
Address (1)
                                                                                   Boat (Commercial purposes only) 
Address (2)                                                                        Aircraft (Specify reason for exempt qualification) ____________________________
City, State, ZIP code                                                                  _______________________________________________________________
                                                                                   Other: _________________________________________________________
Telephone Number
                                                                                 Period of Claim
E-Mail Address                                                                   From  ___________________________  To  ___________________________

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

                         GAS                             -                             =                           X                         =

                         GAS                             -                             =                           X                         =

                         DIESEL                          -                             =                           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: ____________________________
COM/RAD-082     12/23

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                        Attn: Motor Fuel Refund Unit, Room 306B
                                                              110 Carroll Street
      7/1/2017 - 6/30/2018  DSL  .3455                        Annapolis, MD 21411
      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.

COM/RAD-082      12/23