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Get Mfr-43 - Georgia Department Of Revenue - Etax Dor Ga

NE Suite 8223 Atlanta, GA 30345-3205 FEIN: SSN: Period Covered: From: To: Claim may be filed for the 7 cents per gallon excise tax on the non-highway use of taxable clear diesel fuel. Refund claim must be filed within 18 months of the taxable clear diesel purchase. 1. Name of Applicant (Name In Which Clear Diesel Was Purchased): 2. DO NOT USE THIS SPACE Approved Gallons 7 cents Doing Business As (dba): Tax Examiner 3. Location Address: 4. Mailing Address: 5. City State Zi.

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