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      1350                                                STATE OF SOUTH CAROLINA 
                              DEPARTMENT OF REVENUE                                                L-2133 
                                                                                                   (Rev. 6/11/18) 
    dor.sc.gov                MOTOR FUEL REFUND APPLICATION                                                        4222
                              Use a separate application for each refund type.                     File Number
NAME AND ADDRESS              (Instructions on the back.)

                                                                                                   Period Covered

                                                                                                   FEIN/SSN

                                                                                                   Telephone Number

A:
              Type of Refund                              Gasoline/Gasohol Undyed Diesel/Biodiesel Other/Dyed Fuel Total Product

  Federal Government 
    
  State School Bus * 
    
  Product Diverted to                       (Enter State) 
    
  Contaminated Product * 
    
  Regional Transp Authority * 
    
  Other: 
    
  * Do not calculate the inspection and environmental fees for these refund types.

B:    Gasoline     gallons X user fee (see instructions)  $                               Gasoline Refund           
  
C:    Special Fuel            gallons X user fee (see instructions)   $                 Special Fuel Refund         
  
D:    Total Product     gallons X $.0025 = $     Inspec Fee Refund      
  
E:    Total Product           gallons X $.0050 = $                         Enviro Fee Refund  
  
Total Refund Amount (Add Lines B, C, D, and E) $                                    

When signing this form, it is important that the information contained in your report be correct and complete. To 
wilfully furnish a false or fraudulent statement to the Department is a crime.

Print Name:      Signature:      Date: 
  
Email Address:

Mail to:  SC Department of Revenue, P.O. Box 125, Columbia, SC 29214-0400

      42221028



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                                             INSTRUCTIONS FOR L-2133  
                                            MOTOR FUEL REFUND APPLICATION

This refund application should be used to apply for a refund of the fuel user fee and other applicable fees paid on motor 
fuel for the following refund situations. A separate application must be submitted for each refund type. However, you may 
apply for more than one product type on a single application. 
  
All invoices or bills of lading required should clearly show the name of the purchaser, the name of the seller, the date of 
purchase, the number of gallons sold, and the product type. Copies of invoices should be submitted and the originals 
should be retained for three years for audit purposes. 
  
1.  Federal Government 
  a. Product sold to the federal government, its agencies and instrumentalities. Attach copies of the sale invoices 
    showing the gallons sold, the date and the name of the federal government entity. If you are charging the federal 
    government entity the inspection and environmental fees, you are not entitled to a refund for those charges which 
    are passed on to the purchaser. Do not calculate a refund due for those fees. 
    
  b. Product purchased by a federal government agency or instrumentality. You must submit a refund registration form 
    to set up a refund account. Attach copies of purchase invoices indicating that user fees and other applicable fees 
    were charged. 
      
2.  State School Buses: Attach copies of invoices showing the sale of the product for use in state owned school buses 
  used for the pupil transportation program. No refund for other applicable fees is allowed for this refund type. 
  
3.  Product Diverted: A diversion for refund will have South Carolina as the original destination state on the bill of lading. 
  You should combine diversions for refund on one refund application as long as they are all for the same bill of lading 
  date. One application should be submitted even if the product has been diverted to multiple states. A copy of the 
  terminal issued bill of lading is required. The bill of lading should reflect the diversion number obtained from the 
  FuelTrac registry or you may attach a copy of the FuelTrac registry confirmation. No refund will be considered without 
  a valid diversion number. 
  
4.  Contaminated Product: Attach a written explanation of how the product was contaminated, how the product will be 
  disposed of, invoices for the product and any additional information that will substantiate the refund. No refund for 
  other applicable fees is allowed for this refund type. 
  
5.  Regional Transp Authority: Attach copies of the purchase invoices showing that user fee was charged. No refund for 
  other applicable fees is allowed for this refund type. 
  
6.  Other: Use this application to apply for a refund of motor fuel not covered by the situations covered above. Provide a 
  written explanation along with any related invoices or bills of lading. The documentation will depend on the nature of 
  the refund. Call (803) 896-1990 for specific instructions.        
    
Use appropriate user fee rate. See table below: 
  
Effective Dates of Motor Fuel User Fee Increase:                    Motor Fuel User Fee   
Prior to July 1, 2017                                                0.16   
July 1, 2017 - June 30, 2018                                         0.18   
July 1, 2018 - June 30, 2019                                         0.20   
July 1, 2019 - June 30, 2020                                         0.22   
July 1, 2020 - June 30, 2021                                         0.24   
July 1, 2021 - June 30, 2022                                         0.26   
July 1, 2022         0.28   
  
Select the refund type and enter the gallons for each product type to be refunded. Calculate the total gallons for all 
product. Then multiply the correct gallons by the appropriate user fee or other applicable fee rate in B through E. Special 
Fuel includes undyed low sulfur and/or Biodiesel. A refund check will be issued for each user fee and other applicable fee 
category. 
 
Social Security Privacy Act Disclosure 
It is mandatory that you provide your social security number on this tax form, if you are an individual. 42 U.S.C 405(c)(2)(C)(i) permits a state to use an 
individual's social security number as means of identification in administration of any tax. SC Regulation 117-201 mandates that any person required to 
make a return to the SC Department of Revenue shall provide identifying numbers, as prescribed, for securing proper identification. Your social security 
number is used for identification purposes. 
The Family Privacy Protection Act 
Under the Family Privacy Protection Act, the collection of personal information from citizens by the Department of Revenue is limited to the information 
necessary for the Department to fulfill its statutory duties. In most instances, once this information is collected by the Department, it is protected by law 
from public disclosure. In those situations where public disclosure is not prohibited, the Family Privacy Protection Act prevents such information from 
being used by third parties for commercial solicitation purposes. 
Your application must be signed or it will be returned to you. If you need additional information contact this office at 
MotorFuelTax@dor.sc.gov or (803) 896-1990.






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