Form Pda-49 - Special Fuel Tax Return - 2002

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Special Fuel Tax Return
PDA-49
For the month of ______________, ________________. (See instructions on back.)
(month)
(year)
rd
This return must be received in our office on or before the 23
day of the following month.
Minnesota Tax ID:
(See instructions on reverse side)
1
Number of gallons of undyed diesel fuel/kerosene carried forward
1
from Schedule PDA-56 Col. G
2
2
Number of gallons of red dyed diesel fuel/kerosene carried forward from Schedule PDA-49G
3
3
Number of gallons of jet fuel carried forward from Schedule PDA-49J
Column A
Column B
Jet Fuel
Taxable Fuel
4
Total gallons
Column A – Carry forward line 3
4
Column B – Line 1 + Line 2
5
5
Credits from Schedule PDA-49B
6
6
Gallons less credits (subtract line 5 from line 4)
7
7
Evaporation and loss (multiply line 6 by 1% [.01])
8
8
Gallons subject to tax (subtract line 7 from line 6)
9
9 $
.05
$
.20
Tax Rate
10
10
Multiply line 8 by line 9
11
11
Less PDR-1AV (Attached)
Total Tax Due
12
Column A – line 10 minus line 11
12 $
$
Column B – carry forward line 10
$
13
(add line 12, columns A and B)
TOTAL AMOUNT DUE
All payments must be made by
Electronic Funds Transfer (EFT)
I declare that this return is correct to the best of my knowledge and belief. I confess judgement to the State of Minnesota for the amount of the tax shown due to the extent not
timely paid.
Authorized Signature
Title
Date
Phone
(
)
Mail to: Minnesota Department of Revenue, Petroleum Tax Division, St. Paul, MN 55146-3333.
Phone (651) 297-4130 or (800) 657-3596. For TDD/TTY, contact Minnesota Relay at (800) 627-3529
Rev 2/02 - Printed on recycled paper with 10% post-consumer waste

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