Form MDT-ADM-001 "Agricultural Standard Deduction Refund of Montana Diesel and/or Gasoline Tax Application" - Montana

What Is Form MDT-ADM-001?

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 December 1, 2019;
  • 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-001 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-001 "Agricultural Standard Deduction Refund of Montana Diesel and/or Gasoline 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) 444-7664
Phone: (406) 444-7664
Agricultural Standard Deduction Refund of
Agricultural Standard Deduction Refund of
Fax (406) 444-5411
Fax (406) 444-5411
TTY: (406) 444-7696
TTY: (406) 444-7696
MDT-ADM-001
MDT-ADM-001
Rev. 12/19
Rev. 12/19
Montana Diesel and/or Gasoline Tax Application
Montana Diesel and/or Gasoline Tax Application
mdtfueltaxrefund@mt.gov
mdtfueltaxrefund@mt.gov
Page 1 of 3
Page 1 of 3
www.mdt.mt.gov
www.mdt.mt.gov
Time period for Refund:
To:
S-Corp
General Partnership
Individual
Sole Proprietorship
Estate/Trust
C-Corp
Limited Partnership
Individual LLC
Partnership LLC
Corp LLC
Applicant Information
Name (Last, First, MI) or Trade Name:
Tax ID#:
SSN:
-OR-
Mailing Address:
Applicant's Alternate Names and/or any DBA's used
on receipts
City:
State:
Zip + 4:
Phone:
Requested Amounts
The totals below will be calculated based on the information entered into the Itemized Fuel Listing.
Gasoline Total
Diesel Total
Total Refund
+
=
$0.00
$0.00
$0.00
Applicant's Signature
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
To ensure that the applicant's use qualifies as agricultural use, MDT may request state or federal income tax information from the applicant or the department
of revenue to determine eligibility of the Agricultural Standard Deduction.
Paid Preparer's Information
Paid Preparer's Name
Firm's Name
Paid Preparer/Firm's Address
Phone
Paid Preparer Signature
Date
Check the box if you do not want the Department of Transportation to discuss this return with the preparer above.
FOR OFFICE USE ONLY
Date Entered/Processed:
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) 444-7664
Phone: (406) 444-7664
Agricultural Standard Deduction Refund of
Agricultural Standard Deduction Refund of
Fax (406) 444-5411
Fax (406) 444-5411
TTY: (406) 444-7696
TTY: (406) 444-7696
MDT-ADM-001
MDT-ADM-001
Rev. 12/19
Rev. 12/19
Montana Diesel and/or Gasoline Tax Application
Montana Diesel and/or Gasoline Tax Application
mdtfueltaxrefund@mt.gov
mdtfueltaxrefund@mt.gov
Page 1 of 3
Page 1 of 3
www.mdt.mt.gov
www.mdt.mt.gov
Time period for Refund:
To:
S-Corp
General Partnership
Individual
Sole Proprietorship
Estate/Trust
C-Corp
Limited Partnership
Individual LLC
Partnership LLC
Corp LLC
Applicant Information
Name (Last, First, MI) or Trade Name:
Tax ID#:
SSN:
-OR-
Mailing Address:
Applicant's Alternate Names and/or any DBA's used
on receipts
City:
State:
Zip + 4:
Phone:
Requested Amounts
The totals below will be calculated based on the information entered into the Itemized Fuel Listing.
Gasoline Total
Diesel Total
Total Refund
+
=
$0.00
$0.00
$0.00
Applicant's Signature
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
To ensure that the applicant's use qualifies as agricultural use, MDT may request state or federal income tax information from the applicant or the department
of revenue to determine eligibility of the Agricultural Standard Deduction.
Paid Preparer's Information
Paid Preparer's Name
Firm's Name
Paid Preparer/Firm's Address
Phone
Paid Preparer Signature
Date
Check the box if you do not want the Department of Transportation to discuss this return with the preparer above.
FOR OFFICE USE ONLY
Date Entered/Processed:
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) 444-7664
Phone: (406) 444-7664
Agricultural Standard Deduction Refund of
Agricultural Standard Deduction Refund of
Fax (406) 444-5411
Fax (406) 444-5411
TTY: (406) 444-7696
TTY: (406) 444-7696
MDT-ADM-001
MDT-ADM-001
Rev. 12/19
Rev. 12/19
Montana Diesel and/or Gasoline Tax Application
Montana Diesel and/or Gasoline Tax Application
mdtfueltaxrefund@mt.gov
mdtfueltaxrefund@mt.gov
Page 2 of 3
Page 2 of 3
www.mdt.mt.gov
www.mdt.mt.gov
Applicants Name:
Itemized Listing for Fuel Purchased PRIOR to 7/1/19
List all Bulk Storage and Cardtrol Purchases
Receipts
Attach Original Bulk Invoices and Cardtrol
Gasoline
Clear Diesel
Invoice
Prior to 7/1/19
Prior to 7/1/19
Date of Purchase
Number
Dealer
City
State
Eligible Gallons
Eligible Gallons
Column Totals
Itemized Listing for Fuel Purchased On or AFTER 7/1/19
List all bulk, Cardtrol, and Diesel Credit and/or Debit card purchases
Attach Original Bulk Invoices, Cardtrol and Diesel Credit and/or Debit card Receipts
Gasoline
Clear Diesel
Invoice
7/1/19 to Present
7/1/19 to Present
Date of Purchase
Number
Dealer
City
State
Eligible Gallons
Eligible Gallons
Column Totals
PO Box 8019
PO Box 8019
Montana Department of Transportation
Montana Department of Transportation
Helena, MT 59604-8019
Helena, MT 59604-8019
Phone: (406) 444-7664
Phone: (406) 444-7664
Agricultural Standard Deduction Refund of
Agricultural Standard Deduction Refund of
Fax (406) 444-5411
Fax (406) 444-5411
TTY: (406) 444-7696
TTY: (406) 444-7696
MDT-ADM-001
MDT-ADM-001
Rev. 12/19
Rev. 12/19
Montana Diesel and/or Gasoline Tax Application
Montana Diesel and/or Gasoline Tax Application
mdtfueltaxrefund@mt.gov
mdtfueltaxrefund@mt.gov
Page 3 of 3
Page 3 of 3
www.mdt.mt.gov
www.mdt.mt.gov
Schedule A - Agricultural Standard Deduction Refund
A portion of Montana tax on bulk and cardtrol purchases of clear diesel and gasoline is refundable based on percent of gross
earned agricultural income.
Compute Refund
1. Standard Deduction: (required)
%
1
2
3
4
5
Standard Deduction (calculated in
Standard Deduction Worksheet included in
Total Gallons
Standard
Gallons
Montana
the instructions):
Refund
From
Deduction
Subject to
Fuel Tax
If percent of gross earned agricultural income is:
Amount
Itemized Fuel
from Line 1
Refund
Paid Per
50% or greater.........................................Enter 60
(3 x 4)
40% to 49%.............................................Enter 50
Listing
above
(1 x 2 )
Gallon
30% to 39%.............................................Enter 40
0% to 29%.........You do not qualify for this refund
Gasoline Prior to 7/1/19
0%
0
0.315
$0.00
Gasoline 7/1/19 to Present
0%
0
0.320
$0.00
Total Gasoline Refund
$0.00
Text
Diesel Prior to 7/1/19
0%
0
0.2925
$0.00
Diesel 7/1/19 to Present
0%
0
0.2945
$0.00
Total Diesel Refund
$0.00
Page of 3