Form Pda-56b - Other Fuels Multiple Schedule - Minnesota Department Of Revenue
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1MINNESOTA Department of Revenue
PDA-56B
Other Fuels Multiple Schedule
Report for calendar month of ___________________ 19 ________
Company name (same as on license)
License number
Address
City
State
Zip code
Check applicable line. See instructions on back.
Line 1, Gallons received tax unpaid from Minnesota terminals and refineries
Line 3, Gallons imported to Minnesota from the State of ____________________________________
Line 5, Gallons exported from Minnesota to the State of ____________________________________ (submit in duplicate)
A
B
C
D
E
F
G
Point of origin
Name of carrier
Unloaded at
Date
Manifest
Gallons
Terminal
Supplier
(name and location)
number
undyed diesel fuel
Other
Rev. 7/94
TOTALS
Printed on recycled paper with 10% post-consumer waste using soy-based ink.
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Parent category: Financial