Form MDT-ADM-013 "Federal, State, Local Governments and School Districts Refund of Montana Diesel Tax Application" - Montana

What Is Form MDT-ADM-013?

This is a legal form that was released by the Montana Department of Transportation - a government authority operating within Montana. Check the official instructions before completing and submitting the form.

Form Details:

  • Released on September 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-013 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-013 "Federal, State, Local Governments and School Districts Refund of Montana Diesel Tax Application" - Montana

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PO Box 8019
PO Box 8019
Montana Department of Transportation
Montana Department of Transportation
Helena, MT 59604-8019
Helena, MT 59604-8019
Phone: (406) 444-6030
Phone: (406) 444-6030
Federal, State, Local Governments and School
Federal, State, Local Governments and School
Fax (406) 444-5411
Fax (406) 444-5411
TTY: (406) 444-7696
TTY: (406) 444-7696
MDT-ADM-013
MDT-ADM-013
Rev 09/21
Rev 09/21
Districts Refund of Montana Diesel Tax Application
Districts Refund of Montana Diesel Tax Application
mdtfueltaxrefund@mt.gov
mdtfueltaxrefund@mt.gov
Page 1 of 2
Page 1 of 2
www.mdt.mt.gov
www.mdt.mt.gov
Time period for Refund:
To:
Applicant Information:
Name (Last, First, MI) or Trade Name:
Fed ID#:
Mailing Address:
Phone Number:
City:
State: Zip + 4:
Requested Amounts
Note: Privately Owned Buses do not qualify for fuel tax refunds.
Schools & Government Only
Total Gallons
Refund Amount
Total Refund
from Page 2
Per Gallon
Amount
0.2945
$0.00
0.2955
$0.00
Preparer's Information
Preparer's Name
Preparer Address
Phone
Preparer Signature
Date
Check the box if you do not want the Department of Transportation to discuss this return with the preparer above.
I/We hereby declare and represent that the above and foregoing is a true and correct statement showing diesel and/or gasoline
purchased and entirely consumed by the applicant; that the invoices included are the original purchase invoices received at the time
of purchase and delivery; that said claim against the State of Montana is just and wholly unpaid.
Applicant Signature
Date
FOR OFFICE USE ONLY
Date Entered into MFTR:
File Location:
Postmark Date:
PO Box 8019
PO Box 8019
Montana Department of Transportation
Montana Department of Transportation
Helena, MT 59604-8019
Helena, MT 59604-8019
Phone: (406) 444-6030
Phone: (406) 444-6030
Federal, State, Local Governments and School
Federal, State, Local Governments and School
Fax (406) 444-5411
Fax (406) 444-5411
TTY: (406) 444-7696
TTY: (406) 444-7696
MDT-ADM-013
MDT-ADM-013
Rev 09/21
Rev 09/21
Districts Refund of Montana Diesel Tax Application
Districts Refund of Montana Diesel Tax Application
mdtfueltaxrefund@mt.gov
mdtfueltaxrefund@mt.gov
Page 1 of 2
Page 1 of 2
www.mdt.mt.gov
www.mdt.mt.gov
Time period for Refund:
To:
Applicant Information:
Name (Last, First, MI) or Trade Name:
Fed ID#:
Mailing Address:
Phone Number:
City:
State: Zip + 4:
Requested Amounts
Note: Privately Owned Buses do not qualify for fuel tax refunds.
Schools & Government Only
Total Gallons
Refund Amount
Total Refund
from Page 2
Per Gallon
Amount
0.2945
$0.00
0.2955
$0.00
Preparer's Information
Preparer's Name
Preparer Address
Phone
Preparer Signature
Date
Check the box if you do not want the Department of Transportation to discuss this return with the preparer above.
I/We hereby declare and represent that the above and foregoing is a true and correct statement showing diesel and/or gasoline
purchased and entirely consumed by the applicant; that the invoices included are the original purchase invoices received at the time
of purchase and delivery; that said claim against the State of Montana is just and wholly unpaid.
Applicant Signature
Date
FOR OFFICE USE ONLY
Date Entered into MFTR:
File Location:
Postmark Date:
PO Box 8019
Montana Department of Transportation
Montana Department of Transportation
Helena, MT 59604-8019
Phone: (406) 444-6030
Federal, State, Local Governments and School Districts
Federal, State, Local Governments and School Districts
Fax (406) 444-5411
MDT-ADM-013
MDT-ADM-013
Rev. 09/21
Rev. 09/21
TTY: (406) 444-7696
Refund of Montana Diesel Tax
Refund of Montana Diesel Tax
mdtreferrefunds@mt.gov
Page 2 of 2
Page 2 of 2
www.mdt.mt.gov
Federal, State, Local Governments and School Refund
List Tax Paid Diesel Purchases Only
Attach Photocopied Invoices
Gallons
Gallons
purchased
purchased on
Date
Dealer
City
State
Invoice #
prior to
or after
7/1/2021
7/1/2021
+
-
+
-
+
-
+
-
+
-
+
-
+
-
+
-
+
-
+
-
+
-
+
-
+
-
Total Tax Paid Diesel Gallons Purchased According To Date:
Page of 2