Form Pdr-1t - Transit And Ambulance Claim For Refund Page 3
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3Form PDR-1T Instructions (continued)
Information and Assistance
If the period is:
the tax rate is:
If you’re filing under M.S. 256B.0625, subd.
17, use the worksheet on page 2 to deter-
Website:
July 1, 2010 through June 30, 2011 . . 0.275
mine the amount to enter on line 1. The
Email:
petroleum.tax@state.mn.us
July 1, 2011 through June 30, 2012 . . 0.28
miles must match the miles submitted to
Phone: 651-296-0889 (TTY: call 711 for
July 1, 2012 through current . . . . . . . . 0.285
the DHS or Managed Care Organization
Minnesota Relay)
(MCO) for reimbursement.
Direct Deposit
Information is available in other formats
Complete a separate worksheet for gasoline
upon request for persons with disabilities.
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 informa-
tion, you are authorizing the department
and your financial institution to initiate
electronic 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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