Fillable Form Pdr-1t - Transit And Ambulance Claim For Refund (Page 2 of 3) in pdf

Form PDR-1T Instructions

Purpose

Qualified Purposes

Excise tax paid on gasoline or special fuels

is refundable to the end user if used for

There are seven Minnesota Statutes (M.S.) under which a refund may be claimed:

qualified purposes (see “Qualified Purposes”

on this page) or used in a manner that is

M.S. 144E.10 — Ambulance service

M.S. 256B.0625, subd. 17 — Medical

exempt under Minnesota law (M.S. 296A.07,

providers licensed with the Emergency

transportation provided by a special trans-

subd. 4, and M.S. 296A.08, subd. 3). Note: Be

Medical Ground Services Regulatory

portation services provider or common

sure to check our website to ensure you are

Board. These providers are eligible for

carrier recognized by and receiving reim-

using the most current Form PDR-1T.

refund of all state motor fuel and special

bursement from the Minnesota Depart-

fuel excise taxes paid for and used in their

ment of Human Services (DHS) is eligible

Complete this form to claim a refund if you

ambulances.

for refund of state motor fuel and special

are:

fuel excise taxes paid commensurate with

M.S. 144E.12 — Ambulance air service

• a transit system or transit provider who

the reimbursement procedure used by the

providers licensed with the Emergency

received financial assistance or reim-

DHS. DHS reimburses under this statute

Medical Air Services Regulatory Board.

bursement under M.S. 174.24, 256B.0625,

only for mileage while actually provid-

These providers are eligible for refund

subd. 17, or 473.384;

ing transportation, not when the transit

of all state motor fuel and special fuel

vehicle is en route to pick up passenger(s),

• an ambulance service provider licensed

excise taxes paid for and used in their air

commonly referred to as loaded miles.

under M.S. 144E.10 or 144E.12;

ambulances.

No-Load Miles: ATS and STS miles

• providers of transportation to recipients

M.S. 174.24 — Any public or private op-

driven without the recipient in the vehicle

of medical assistance home and com-

erator of a transit system that is contracted

are considered an excluded cost of trans-

munity-based services waivers enrolled

to and receiving financial assistance from

portation. The miles are not reimbursable

in day programs, including adult day

the Minnesota Department of Transporta-

and cannot be billed to the recipient.

care, family adult day care, day treatment

tion in the Public Transit Participation

and habilitation, prevocational services

Program is eligible for refund of all state

M.S. 296A.07 Subd. 4 (2)/296A.08,

and structured day services under M.S.

motor fuel and special fuel excise taxes

subd. 3 (2) — Providers of transportation

296A.07 Subd.4(2) or 296A.08 Subd.3(2);

paid. The refund is only for fuel used

to recipients of medical assistance home

in vehicles that actually provide transit

and community-based services waiv-

services. Note: This program is only for

ers enrolled in day programs, including

• providers of medical or dental services

transit providers outside the Twin Cities

adult day care, family adult day care, day

by a federally qualified health center,

metropolitan area.

treatment and habilitation, prevocational

as defined under title 19 of the Social

services and structured day services.

Security Act, as amended by Section 4161

M.S. 473.384 — Any public or pri-

of the Omnibus Budget Reconciliation

vate operator of a transit system that is

M.S. 296A.07 Subd. 4 (4)/296A.08,

Act of 1990, with a motor vehicle used

contracted to and receiving financial

subd. 3 (4) — Providers of medical or

exclusively as a mobile medical unit un-

assistance from the Metropolitan Coun-

dental services by a federally qualified

der M.S. 296A.07 Subd.4(4) or 296A.08

cil to provide transit services within the

health center, as defined under title 19

Subd.3(4).

metropolitan area is eligible for refund of

of the Social Security Act, as amended

all state motor fuel and special fuel excise

by Section 4161 of the Omnibus Budget

You must attach a separate schedule pro-

taxes paid. The refund is only for fuel used

Reconciliation Act of 1990, with a motor

viding a list of all qualifying vehicles in

in vehicles that actually provide transit

vehicle used exclusively as a mobile medi-

which the fuel was used.

services. Note: This program is only for

cal unit.

Each claim must cover only a one-month

transit providers within the Twin Cities

period. Only one claim per period is al-

metropolitan area.

lowed and if corrections to the original

claim are necessary, an amended claim must

fuel on which the motor fuel tax has been

For more information, see Sales Tax Fact

be filed.

refunded is subject to Minnesota sales and

Sheet #116, Petroleum Products, send an

Your claim for refund is subject to audit.

use tax, unless specifically exempted by

email to SalesUse.Tax@state.mn.us or call

You must keep all records pertaining to this

law. Examples of fuel specifically exempted

651-296-6181 or 1-800-657-3777.

claim (receipts, mileage logs, bills of lading,

from sales and use tax include fuel used in

fuel logs, transportation reimbursement

Line Instructions

a qualifying manner, such as: in agricultural

requests from other state agencies, etc.) for

or industrial production; in certain taxable

Line 1 — Method of Calculating Refund

at least 3½ years. Do not send in copies of

services or ambulance services; or in certain

‘If you’re filing under M.S. 144E.10, 144E.12,

receipts or invoices.

fire trucks, emergency rescue vehicles and

174.24, 296A.07 subd. 4(2)/296A.08 subd.

special fuels used in qualifying law enforce-

Sales and Use Tax

3(2), M.S. 296A.07, subd. 4(4)/296A.08

ment vehicles operated by state and local

subd. 3 (4), or 473.384, enter the number

If you receive a refund of petroleum taxes

governments.

of gallons of fuel used during the month in

paid, you may be required to pay Min-

eligible vehicles.

nesota use tax on those purchases. The

Continued

(Rev. 2/13)

Form Pdr-1t - Transit And Ambulance Claim For Refund Page 2

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