Form Pda-49r - Special Fuel Dealer'S Report - Minnesota Department Of Revenue

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PDA-49R
Special Fuel Dealer’s Report
Use this schedule to report all undyed fuel purchases placed into retail storage for subsequent resale. 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 excessive gain.
Company name (same as on license)
Month/year
Address
City
State
Zip code
Purchase
Supplier’s
Supplier’s
Invoice
Gallons
date
license number
name
number
received
Product reconciliation
1 Beginning inventory . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2 Purchases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3 Total available for sale (add lines 1 and 2) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4 Less sales (total metered sales from below) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5 Book inventory . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6 Measured inventory . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
7 Loss or gain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Meter readings
Open
Close
Sales
Total metered sales (enter on line 4 above)
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 651-297-4130. TTY: Call 711 for Minnesota Relay.
(Rev. 7/04)

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