Form MDT-ADM-009 "State Fuel Tax Remittance Form" - Montana

What Is Form MDT-ADM-009?

This is a legal form that was released by the Montana Department of Transportation - a government authority operating within Montana. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on July 1, 2021;
  • The latest edition provided by the Montana Department of Transportation;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form MDT-ADM-009 by clicking the link below or browse more documents and templates provided by the Montana Department of Transportation.

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Download Form MDT-ADM-009 "State Fuel Tax Remittance Form" - Montana

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Motor Fuels Section
2701 Prospect Avenue
Montana Department of Transportation
PO Box 201001
State Fuel Tax Remittance Form
Helena MT 59620-1001
Phone: (406) 444-0806
MDT-ADM-009
Rev. 07/2021
Dyed diesel fuel accidentally put into the supply tank of an on-highway vehicle
Fax: (406) 444-5411
TDD: (406) 444-7696
www.mdt.mt.gov
Information:
Use this form to report and pay the state fuel tax in the event of an accidental fueling of dyed diesel fuel into a
highway vehicle. The vehicle that contains dyed diesel fuel may be operated on Montana's public roads if the driver
can show a photocopy of this completed form and if tax payment has been made to the Montana Department of
Transportation.
The state fuel tax rate is $.2955 per gallon.
This form addresses Montana state tax only.
Complete this form, attach payment for the amount of tax due and mail to the address shown. Keep a copy in your
vehicle.
Name:
Date:
Address:
Phone:
City:
State/Province
Zip Code:
Vehicle Information
Model
VIN No.
Make
Year
Odometer
Summary
Number of gallons of dyed diesel put into the supply tank of the vehicle:
Payment Calculation:
$0.00
Multiplies gallons by $.2955
Sign below and remit to:
Montana Department of Transportation
Fiscal Operations Bureau
PO Box 5895
Helena MT 59604-5895
I declare, under penalties of perjury, that this remittance form has been examined by me and to the best of my
knowledge and belief is true, correct and complete.
Title:
Date:
Signed By
By cooperative agreement, the Montana Department of Transportation exchanges fuel tax information with other tax collecting
agencies. Alternate accessible formats of this document will be provided up on request.
Motor Fuels Section
2701 Prospect Avenue
Montana Department of Transportation
PO Box 201001
State Fuel Tax Remittance Form
Helena MT 59620-1001
Phone: (406) 444-0806
MDT-ADM-009
Rev. 07/2021
Dyed diesel fuel accidentally put into the supply tank of an on-highway vehicle
Fax: (406) 444-5411
TDD: (406) 444-7696
www.mdt.mt.gov
Information:
Use this form to report and pay the state fuel tax in the event of an accidental fueling of dyed diesel fuel into a
highway vehicle. The vehicle that contains dyed diesel fuel may be operated on Montana's public roads if the driver
can show a photocopy of this completed form and if tax payment has been made to the Montana Department of
Transportation.
The state fuel tax rate is $.2955 per gallon.
This form addresses Montana state tax only.
Complete this form, attach payment for the amount of tax due and mail to the address shown. Keep a copy in your
vehicle.
Name:
Date:
Address:
Phone:
City:
State/Province
Zip Code:
Vehicle Information
Model
VIN No.
Make
Year
Odometer
Summary
Number of gallons of dyed diesel put into the supply tank of the vehicle:
Payment Calculation:
$0.00
Multiplies gallons by $.2955
Sign below and remit to:
Montana Department of Transportation
Fiscal Operations Bureau
PO Box 5895
Helena MT 59604-5895
I declare, under penalties of perjury, that this remittance form has been examined by me and to the best of my
knowledge and belief is true, correct and complete.
Title:
Date:
Signed By
By cooperative agreement, the Montana Department of Transportation exchanges fuel tax information with other tax collecting
agencies. Alternate accessible formats of this document will be provided up on request.