NEED HELP? Click here to view video tutorial for this form

Logo that says Form 4923-H inside a Missouri graphic.
Image
Car with the tax rate of $0.075 displayed
Image

For Motor Fuel Tax Paid July 1, 2023 through June 30, 2024 Claim must be postmarked July 1, 2024 through September 30, 2024

Section 142.822 - (Motor Fuel Tax Law)

WARNING: This form cannot be saved to be completed at a later time. You must complete the form in its entirety once you begin. 

This form is used to claim a refund for the increased portion of the motor fuel tax paid on fuel used for on road purposes. Refund claims must be postmarked on or after July 1, but no later than September 30 following the fiscal year ending June 30, 2024. You must provide information detailing the fuel purchased for each vehicle by vehicle identification number (VIN). Motor fuel purchased for and consumed by a motor vehicle with a gross weight of 26,000 pounds or less is eligible.

If you have questions or need assistance in completing this form, please call this office at (573) 751-7671, (TTY (800) 735-2966) or email this office at: motorfuelrefunds@dor.mo.gov. You may also access a copy of this form on the Department’s website: dor.mo.gov/forms.

Claimant
  • Enter the information requested for who is filing the refund claim
  • Either click next when the information is complete or click on the Claimant Part 2 tab on the left.
Claimant Part 2
  • Enter the address information to which the refund will be mailed. 
  • Enter the email address for the person filing the claim who can be contacted if there are any questions.  
  • Either click next or click on the Worksheet of Missouri Motor Fuel Tax Paid by Vehicle tab on the left.
Worksheet of Missouri Motor Fuel Tax Paid by Vehicle
A separate worksheet must be submitted for each vehicle. You cannot enter more than 75 receipts for each vehicle. If you need to enter more than 75 receipts for a vehicle, add another worksheet to enter the additional receipts.

Enter additional receipts for this vehicle by clicking “+”. If you are finished entering receipts for this vehicle, scroll down to enter receipts for another vehicle or if you are finished entering receipts for all vehicles, click the “Next” button.” 

Enter receipts for another vehicle, by clicking “+” and then click the “Next” button. If you are finished entering receipts for all vehicles, click the “Next” button.” 

Vehicle and Fuel Information
Enter the summarized information for each Worksheet of Missouri Motor Fuel Tax Paid by Vehicle.
  • Vehicle Identification Number (VIN) - Enter the Vehicle Identification Number (VIN) from each worksheet. 
  • Select box if Vehicle Does Not Exceed 26,000 Pounds - Check the box to verify the vehicle for which the refund is being claimed has a gross weight of 26,000 pounds or less. 
  • Enter the total rounded gallons for each vehicle from each of the worksheets completed. Only one fuel type per vehicle may be entered.
  • Total Missouri Motor Fuel Tax Increase Paid – This will calculate based upon the number of gallons entered.
Only one fuel type per vehicle may be entered

Enter additional vehicles by clicking “+”. If you are finished entering vehicles, scroll down to Refund Claimed. Verify the totals match your records and click the “Next” button if you agree. If the totals do not match, verify what you have entered. Once you agree, click “Next”. 

Total
  • This section will calculate based on the information entered for each VIN. 
Refund Claimed

Review the calculated amount. If you disagree, review the information entered on all tabs. If you agree, either click the next button or click on the Signature tab on the left. 

Signature Instructions
  • Enter the requested information.
  • Click the Submit button
If you would like your refund deposited directly into your checking or savings account, complete boxes a, b, and c below.

Under penalties of perjury, I declare that the above information and any attached supplement is true, complete, and correct. I state that I have prepared or reviewed this claim and take full responsibility for the information thereon, that I have made the purchases and used the motor fuel as shown above and paid the tax on the original invoices and that I am entitled to the refund amount claimed.

 

You have submitted a motor fuel highway refund claim to the Department of Revenue.

 

The FormID for this transaction is: {formuniqueid}. To view a copy of the submitted form, select the print button below. Print or save a copy of the form for your records.

 

If you would like to check the status of this refund claim, please email motorfuelrefunds@dor.mo.gov. Please allow 2-4 weeks for processing your claim.

 

Taxation Division

 

This electronic transmission may contain information that is confidential, privileged, and prohibited from disclosure and unauthorized use pursuant to applicable law.

If you are the intended recipient of this transmission, be advised that its use is restricted by law and for the purpose stated herein.