Form Pda-56 - Gasoline And Other Fuels Multiple Schedule

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PDA-56
Gasoline and Other Fuels Multiple Schedule
Company name
Minnesota tax ID number
Address
City
State
Zip code
Month/year
Check applicable line. See instructions on back.
Shipments received from Minnesota terminals and refineries on which tax was not paid (enter totals on line 1 of PDA-46)
Shipments imported to Minnesota from the state of
(enter totals on line 2 of PDA-46)
(enter totals on line 4 of PDA-46)
Shipments exported from Minnesota to the state of
A
B
C
D
E
F
G
H
Point of Origin
Name of Carrier
Unloaded at
Date
Manifest
Gallons
Gallons
Other
Terminal
Supplier
(name and location)
Number
gasoline
undyed diesel fuel
Phone: 651-296-0889 (TTY: Call 711 for Minnesota Relay). Email: petroleum.tax@state.mn.us
TOTALS
(Rev. 8/11)

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