Form Pda-49 - Special Fuel Tax Return
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1
2PDA-49
Special Fuel Tax Return
File and pay electronically by the 23rd day of the following month. You must file a return even if no activity has taken
place during the month .
For the month of
,
.
(month)
(year)
Company name
Minnesota tax ID number
Address
City
State
Zip code
1 Total gallons of undyed diesel fuel/kerosene (from all Schedules PDA-56, column G) . . . . . . . . . . . . . . . . 1
2 Total taxable gallons of dyed diesel fuel/kerosene sold to governmental units
and for use in buses (from all Schedules PDA-49G) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
3 Total taxable gallons of jet fuel (from Schedule PDA-49J) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Column A
Column B
Jet Fuel
Taxable Fuel
4 Total gallons
Column A: Enter the amount from line 3
Column B: Enter the sum of line 1 and line 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
5 Credits (total gallons from all Schedules PDA-49B) . . . . . . . . . . . . . . . . . . . . . . . 5
6 Gallons less credits (subtract line 5 from line 4) . . . . . . . . . . . . . . . . . . . . . . . . . 6
7 Evaporation and loss allowance (multiply line 6 by 1% [.01]) . . . . . . . . . . . . . . . 7
8 Gallons subject to tax (subtract line 7 from line 6) . . . . . . . . . . . . . . . . . . . . . . . . 8
.05
9 Tax rate (Column B: determine from instructions) . . . . . . . . . . . . . . . . . . . . . . . . 9
10 Multiply line 8 by line 9 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 $
$
11 Aviation fuel tax claim for refund
Column A only: Enter amount from line 8 of Form PDR-1AV . . . . . . . . . . . . . . . 11 $
12 Qualifying service station adjustment
Column B only: Enter amount from line 4 of Schedule PDA-49Q . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 $
13 Total tax
Column A: Subtract line 11 from line 10, column A
Column B: Subtract line 12 from line 10, column B . . . . . . . . . . . . . . . . . . . . . . 13 $
$
All payments must be paid
electronically (see instructions)
14 TOTAL AMOUNT DUE (add line 13, columns A and B) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 $
I declare that this return and supporting schedules are correct and complete to the best of my knowledge and belief. I confess judgment to the state of
Minnesota for the amount of the tax shown due to the extent not timely paid.
Authorized signature
Title
Date
Daytime phone
File and pay electronically at www .revenue .state .mn .us . Keep a signed copy of this return with your tax records .
Phone: 651-296-0889 (TTY: Call 711 for Minnesota Relay) . Email: petroleum .tax@state .mn .us
(Rev . 03/13)
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