Indiana Form GA-110LMP is a refund claim document designed specifically for individuals or organizations seeking reimbursement of sales tax paid on gasoline, gasohol, or special fuel that was dispensed through stationary metered pumps and subsequently used for tax-exempt purposes. This form allows eligible taxpayers to recover the sales tax component paid at the pump when fuel was purchased for activities that qualify for exemption under Indiana Code Section 6-2.5 of the State Gross Retail Sales Act. The form applies exclusively to fuel transactions that occurred during specific historical periods, as legislative changes have altered the taxability of these fuels over time. Notably, gasoline and gasohol ceased to be subject to sales tax effective July 1, 2014, meaning claims for periods after June 30, 2014, must use a different form. Similarly, special fuels such as diesel, liquid natural gas, and compressed natural gas were removed from sales tax obligations starting July 1, 2017, rendering this form inapplicable for claims after that date. By completing this document, taxpayers can calculate and request refunds based on the difference between the total purchase price and the excise taxes embedded in fuel costs, then apply the applicable sales tax rate to determine the refundable amount.
Important Notes Before Filing
Fuel Type Eligibility and Date Restrictions
As of July 1, 2014, gasoline and gasohol are no longer subject to sales tax in Indiana. Therefore, you should not use Form GA-110LMP to claim refunds for gasoline or gasohol purchased after June 30, 2014. For refund claims related to gasoline use tax for periods beginning July 1, 2014, you must file Form GA-110L instead.
As of July 1, 2017, special fuel is no longer subject to sales tax. Do not claim refunds for special fuel on Form GA-110LMP for periods after June 30, 2017.
Special fuels covered by this form include diesel, liquid natural gas, and compressed natural gas.
Submission Instructions
Mail the completed form along with all supporting receipts to:
Indiana Department of Revenue
Special Tax Section
P.O. Box 1971
Indianapolis, IN 46206-1971
Retain a copy of the completed form and all receipts for your personal records.
For assistance, contact the department at (317) 615-2552 or email [email protected].
How to Complete Indiana GA-110LMP Form
Taxpayer Identification Section
Name of Taxpayer: Enter the full legal name of the individual or organization filing the claim.
Taxpayer Identification Number (TID): Provide your Indiana Taxpayer Identification Number as issued by the state.
Address: Write your complete street address.
Social Security or Federal ID Number: Enter either your Social Security Number (for individuals) or Federal Employer Identification Number (for businesses).
City / State / ZIP Code: Complete your mailing address with city, state abbreviation, and postal code.
US DOT Number: If applicable, provide your United States Department of Transportation identification number.
Description of Exempt Use
Period: Specify the time period for which you are filing the refund claim (e.g., January 1 – March 31, 2014).
Fuel Type: Indicate whether the fuel was gasoline, gasohol, or special fuel.
Exempt Use: Describe in detail how the fuel was used for exempt purposes. Attach additional sheets if more space is needed.
Calculation Section
Complete the calculation table for each applicable fuel type by filling in Columns A (Gasoline), B (Gasohol), and/or C (Special Fuel).
Line 1 – Total Gallons Purchased for Exempt Use: Enter the total number of whole gallons purchased for exempt purposes as shown on your receipts. You must attach these receipts to your claim.
Line 2 – Total Purchase Price: Write the total dollar amount you paid for the gallons entered on Line 1.
Line 3 – Combined State and Federal Rate: This rate is pre-printed on the form. For gasoline and gasohol, the rate is .364. For special fuel, the rate is .404. These rates can also be found in Departmental Notice #12 available on the Indiana Department of Revenue website.
Line 4 – Total State and Federal Excise Tax Included in Sales: Calculate this amount by multiplying the number of gallons on Line 1 by the rate shown on Line 3. Enter the result on Line 4.
Line 5 – Taxable Amount: Subtract the amount on Line 4 from the amount on Line 2. Enter the difference on Line 5.
Line 6 – Total Sales Tax Paid on Exempt Gallons for Exempt Purposes: Calculate the sales tax refund amount by multiplying the amount on Line 5 by .0654 (which represents 6.54%). This is the refund amount you are claiming for each fuel type.
Line 7 – Total Requested Refund Amount: Add together the amounts from Line 6 for Columns A, B, and C. This is your total refund claim across all fuel types.
Certification and Signature
By signing this form, you certify under penalty of perjury that:
- Sales tax has been paid on the fuel purchases shown on the attached receipts
- The fuel was dispensed through stationary metered pumps
- The fuel was used for purposes exempt under Indiana Code Section 6-2.5
- No other refund claim has been filed for the purchases shown on the attached receipts
- You understand the refund may be applied to any outstanding tax liability you currently owe
- All information provided is true, accurate, and complete to the best of your knowledge
Signature of Applicant: Sign your name here.
Telephone Number: Provide a daytime contact number.
Printed Name: Print your full legal name.
Email Address: Enter your email address for correspondence.
Title: If filing on behalf of an organization, enter your job title or position.
Date: Write the date you are signing the form.
Representative Authorization
If a taxpayer representative is filing this claim on your behalf, they must have a valid POA-1 (Power of Attorney Form) on file with the Indiana Department of Revenue.
Administrative Use Only
The bottom portion of the form containing spaces for Auditor/Tax Analyst, Supervisor/Administrator, and Commissioner/Appointee signatures and dates should be left blank. These are for internal department use only.