Form Pda-78 - Special Fuel Auditor'S Report Form - Minnesota Revenue

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PDA-78
Special Fuel Auditor’s Report
Gallons received
Purchase
Supplier’s
Supplier’s Minnesota
Gasoline
Dyed fuel
Undyed fuel
date
name
tax ID number
oil
oil
Totals (enter on line 1 below)
Product reconciliation
Gasoline
Dyed fuel oil
Undyed fuel oil
1 Total gallons to be reported this month (enter total from above) . . . . . . .
2 Other purchases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3 Total of all receipts (add lines 1 and 2) . . . . . . . . . . . . . . . . . . . . . . . . . . .
4 First-of-month inventory . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5 Total to account for (add lines 3 and 4) . . . . . . . . . . . . . . . . . . . . . . . . . . .
6 Sales and company use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
7 Subtract line 6 from line 5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
8 End-of-month book inventory . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
9 End-of-month measured readings (see worksheet below) . . . . . . . . . . . . .
10 Loss or gain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Worksheet for line 9
Gasoline
Dyed fuel oil
Undyed fuel oil
1 Gasoline . . . . . . . . . . . . . . . . . . .
ft
in . . . .
2 Number 1 fuel . . . . . . . . . . . . . . .
ft
in . . . .
3 Number 2 fuel . . . . . . . . . . . . . . .
ft
in . . . .
4 Kerosene . . . . . . . . . . . . . . . . . .
in . . . .
ft
5 Other . . . . . . . . . . . . . . . . . . . . .
in . . . .
ft
6 Total (enter on line 9 above) . . . . .
in . . . .
ft
7 In tank wagons (gallons) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Minnesota Revenue, Mail Station 3333, St. Paul, MN 55146-3333. Phone 651-297-4130. TTY: Call 711 for Minnesota Relay.
(Rev. 9/07)

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