Form Pdr-1t - Transit And Ambulance Claim For Refund Page 3
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3Form PDR-1T Instructions (continued)
If you’re filing under M.S. 256B.0625,
If the period is:
the tax rate is:
Information and Assistance
subd. 17, use the worksheet on page 2 to
July 1, 2010 through June 30, 2011 . 0.275
Website:
determine the amount to enter on line 1.
Email:
petroleum.tax@state.mn.us
July 1, 2011 through June 30, 2012 . 0.28
The miles must match the miles submitted
Phone: 651-296-0889
July 1, 2012 through current . . . . . . . 0.285
to the DHS or Managed Care Organization
This material is available in alternate
(MCO) for reimbursement.
Direct Deposit
formats.
Complete a separate worksheet for gasoline
If you want the full refund from line 4 to
and special fuels. The worksheets must be
be directly deposited into your checking
included when you file the refund claim.
or savings account, enter the routing and
account numbers. You must use an account
Line 2 — Tax Rates
not associated with any foreign banks.
A surcharge is imposed on all motor fuels
effective Aug. 1, 2008, and is updated an-
If the routing or account number is incor-
nually.
rect or is not accepted by your financial
institution, your refund will be sent to you
Using the list below and the month of the
in the form of a paper check.
return you are filing, determine the tax rate
to enter on line 2, columns A and B.
By providing your banking information,
you are authorizing the department and
your financial institution to initiate elec-
tronic credit entries, and if necessary, debit
entries and adjustments for any credits
made in error.
Worksheet for Filings Under M.S. 256B.0625, subd. 17
For each type of vehicle, enter the number of vehicles used during the month. For “number of miles,” enter the miles driven as reported to the
DHS or MCOs (sometimes referred to as loaded miles). Include a copy of this worksheet with your claim.
Buses (number of vehicles
)
1 Number of miles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
2 Multiply line 1 by 1.5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
3 Bus gallons (divide line 2 by 4 mpg) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Taxis (number of vehicles
)
4 Number of miles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
5 Multiply line 4 by 1.5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
6 Taxi gallons (divide line 5 by 15 mpg) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Minivans (number of vehicles
)
7 Number of miles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
8 Multiply line 7 by 1.5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
9 Minivan gallons (divide line 8 by 15 mpg) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Maxivans (number of vehicles
)
10 Number of miles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
11 Multiply line 10 by 1.5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
12 Maxivan gallons (divide line 11 by 11 mpg) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
13 Total gallons (add lines 3, 6, 9 and 12) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Enter this amount on line 1 of the form. Attach a copy of this worksheet to your Form PDR-1T.
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