Form Pda-46q - Petroleum Division - Minnesota Department Of Revenue

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PDA-46Q

Petroleum Division

Sheet number

Company name (same as on license)

Minnesota tax ID number

Address

Month/year

City

State

Zip code

Master jobber

Check one:

Aviation gasoline

Gasoline sales to qualifying service station

E-85 fuel

Sold to

Mailing address

Town delivered to

Date

Ticket number

Gallons

Total gallons

1 Evaporation and loss allowance (multiply total gallons by 2.5 percent [.025] ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

2 Net gallons subject to rate reduction (subtract line 1 from total gallons) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

3 Tax rate reduction per gallon . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

4 Tax adjustment to be added to PDA-46, line 16 (multiply lines 2 and 3) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Minnesota Revenue, Mail Station 3333, St. Paul, MN 55146-3333. Phone 651-297-4130. TTY: Call 711 for Minnesota Relay.

(Rev. 4/04)