Forms And Instructions For Application Form For Refund Of Montana Diesel Or Gasoline Tax Page 20

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Tear Here
Tear Here
Power Take-Off Unit (PTO) Refund
See Instructions on the back of this form.
Schedule C
List all Vehicles with PTOs
Attach this schedule to the application (form page 1).
Undyed Diesel
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Average
Montana
Fuel Used in
PTO Fuel
Miles
Total Fuel
Total
Montana
PTO Fuel
Vehicle Identification Number
Vehicle Type #
Miles per
On-Road
Montana
Rate
operated in
Used in
Montana
Off-Road
all
(VIN)
(See Backside)
Gallon
Miles
(See
Vehicles
Miles
Miles
(7) X (8)
Jurisdictions
(1) ÷ (2)
(4) - (5)
(6) ÷ (3)
Backside)
Total Undyed Diesel used in Montana by PTOs.
This page may be copied if you have additional vehicles.
Total Undyed Diesel Gallons multiplied by $0.2775 (Enter total amount on Line 13 of MF-Refund form page 1)
$
Gasoline
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Average
Montana
Fuel Used in
PTO Fuel
Miles
Total Fuel
Total
Montana
PTO Fuel
Vehicle Identification Number
Vehicle Type #
operated in
Miles per
On-Road
Montana
Rate
Used in
Montana
Off-Road
all
Gallon
Miles
(See
(VIN)
(See Backside)
Jurisdictions
Vehicles
Miles
Miles
(7) X (8)
(1) ÷ (2)
(4) - (5)
(6) ÷ (3)
Backside)
Total Gasoline Gallons used in Montana by PTOs.
This page may be copied if you have additional vehicles.
$
Total Gasoline Gallons multiplied by $0.27
(Enter total amount on Line 13 of MF-Refund form page 1)
Form Page 7

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