Form Pda-49bd - Biodiesel Report Form - Department Of Revenue - Minnesota

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PDA-49BD
Biodiesel Report
Use this schedule to report all biodiesel blended with undyed diesel or dyed diesel fuel for use in a combustible engine. This report,
governed by Minnesota Statute 296, must be completed each month and retained by the company. The company is responsible for tax due
on biodiesel products blended with diesel fuels.
Company name (same as on license)
Minnesota tax ID or Social Security number
Address
City
State
Zip code
Month/year
B100 purchases
Purchase
Supplier’s
Supplier’s MN tax
Biodiesel blended with
Biodiesel blended with
date
name
ID number
undyed diesel (gallons)
dyed diesel (gallons)
Total gallons
(enter on line 1 below)
Self-produced biodiesel
Date
Origin of
Blended with
Blended with
blended
product
undyed diesel (gallons)
dyed diesel (gallons)
Total gallons
(enter on line 2 below)
Tax calulations
1 Total gallons of manufactured B100 blended with undyed diesel fuels . . . . . . . . . . . . . . . . . . .
2 Total gallons of self-produced product blended with undyed diesel fuels . . . . . . . . . . . . . . . . . .
3 Add lines 1 and 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4 Total excise tax due (multiply line 3 by $0.20) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Check method of payment:
Electronic payment
Check
(make payable to Minnesota Revenue)
Assessments for Inspection Fee will be invoiced on an annual basis.
Assessments for Clean Up will apply during the months the fee is active.
I declare under the penalties of criminal liability for willfully making any false statements, that this claim has been
examined by me and to the best of my knowledge and belief is true and complete for the taxable period stated.
Authorized signature and title
Date
Daytime phone
Minnesota Revenue, Mail Station 3333, St. Paul, MN 55146-3333. Phone 651-296-0889. TTY: Call 711 for Minnesota Relay.
(Rev. 12/05)

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