Logo that says Form 4923-H inside a Missouri graphic.
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Car with the tax rate of $0.075 displayed
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For Motor Fuel Tax Paid July 1, 2023 through June 30, 2024 Claim must be postmarked July 1, 2024 through September 30, 2024

This form has been moved to a new enterprise environment. Please find the new form at: 

https://formsportal.mo.gov/content/forms/af/moa/department-of-revenue/form2923-h/Form4923-h.html