Form Pdr-1 - Minnesota Motor Fuel Claim For Refund
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1
2PDR-1
Minnesota Motor Fuel Claim for Refund
Complete a separate claim for each month. Read instructions on back.
Check if filing:
Original claim; or
You must list nonlicensed equipment on the back or your claim will be returned to you.
Amended claim
Period (enter month and year)
Minnesota tax ID (if a business) or Social Security number
Name
Check reason(s) for filing claim:
Airline ground use
Landscaping
Biodiesel
Logging
Address
Check if new address
Construction
Refrigeration units
Farming
Well drilling
City
State
Zip code
Kerosene
Other:
Form PDR-1 and Schedule PDR-1PTO are available at If you
Send more Forms PDR-1
do not have access to the Internet and need forms mailed to you, check the box(es):
Send more Schedules PDR-1PTO
List nonlicensed equipment on the reverse side.
Column A
Column B
Gasoline
Undyed Diesel/Kerosene
(in whole gallons)
(in whole gallons)
1 Gallons used off the highway in equipment other than to operate
.00
.00
power take-off (PTO) units on which tax was paid (round to whole gallons) . . . . 1
2 PTO gallons subject to refund (round to whole gallons)
.00
.00
(attach Schedule PDR-1PTO) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
.00
.00
3 Total gallons eligible for refund (add lines 1 and 2) . . . . . . . . . . . . . . . . . . . . . . . 3
.
.
4 Tax rate (determine from the instructions on back of this form) . . . . . . . . . . . . 4
5 Multiply line 3 by line 4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 $
$
6 Gasoline and special fuel tax refund (add line 5, columns A and B) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 $
To have your refund direct deposited, enter the following. Otherwise, you will receive a check.
Account type:
Routing number
Account number
Checking
Savings
All refunds are subject to audit by the Department of Revenue.
I declare under the penalties of criminal liability for willfully making any false statements herein, that this refund claim has
been examined by me and to the best of my knowledge and belief is true and complete.
Authorized signature
Title
Date
Daytime phone
You must keep records pertaining to miles traveled and fuel purchased for at least 3½ years.
You must keep all records regarding this refund (fuel receipts, bulk purchase receipts, bills of lading, fuel logs and IFTA
reports) for at least 3 1/2 years.
Mail Form PDR-1 and your list of nonlicensed equipment to:
Minnesota Revenue, Petroleum Taxes, Mail Station 4108, St. Paul, MN 55146-4108.
Phone: 651-296-0889 (TTY: Call 711 for Minnesota Relay). Email: petroleum.tax@state.mn.us
(Rev. 5/13)
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