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 the instructions before you complete
Check if filing:
Original claim; or
this form. You must list nonlicensed equipment or your claim will be returned to you.
Amended claim
Minnesota Tax ID (if a business) or Social Security Number
Period (enter month and year)
Name
Check reason(s) for filing claim:
Airline ground use
Landscaping
Biodiesel
Logging
Address
Check if new address
Construction
Refrigeration units
City
State
ZIP Code
Farming
Well drilling
Kerosene
Other:
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
0.
0.
4 Tax rate (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 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
Gasoline Nonlicensed Equipment
Gallons
Diesel Nonlicensed Equipment
Gallons
(round to whole gallons)
(round to whole gallons)
If you need more space, enclose a separate sheet of paper.
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 all records regarding this refund (miles traveled, fuel receipts, bills of lading, fuel logs and IFTA reports) for at least
3
years.
1
/
2
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.
Email: petroleum.tax@state.mn.us
(Rev. 8/17)
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