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

This version of the form is not currently in use and is provided for reference only.
Download this version of Form MDT-ADM-013 for the current year.

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 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-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
Montana Department of Transportation
Helena, MT 59604-8019
Phone: (406) 444-7664
Federal, State, Local Governments and School
Fax (406) 444-5411
TTY: (406) 444-7696
MDT-ADM-013
Rev 12/19
Districts Refund of Montana Diesel Tax Application
mdtfueltaxrefund@mt.gov
Page 1 of 2
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
0.2925
$0.00
0.2945
$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
Paid Preparer's Information
Preparer's Name
Firm'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.
FOR OFFICE USE ONLY
Date Entered/Processed:
File Location:
Postmark Date:
PO Box 8019
Montana Department of Transportation
Helena, MT 59604-8019
Phone: (406) 444-7664
Federal, State, Local Governments and School
Fax (406) 444-5411
TTY: (406) 444-7696
MDT-ADM-013
Rev 12/19
Districts Refund of Montana Diesel Tax Application
mdtfueltaxrefund@mt.gov
Page 1 of 2
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
0.2925
$0.00
0.2945
$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
Paid Preparer's Information
Preparer's Name
Firm'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.
FOR OFFICE USE ONLY
Date Entered/Processed:
File Location:
Postmark Date:
PO Box 8019
Montana Department of Transportation
Helena, MT 59604-8019
Phone: (406) 444-7664
Federal, State, Local Governments and School Districts
Fax (406) 444-5411
MDT-ADM-013
Rev. 06/19
TTY: (406) 444-7696
Refund of Montana Diesel Tax
mdtreferrefunds@mt.gov
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
7/1/2019
7/1/2019
+
-
+
-
+
-
+
-
+
-
+
-
+
-
+
-
+
-
+
-
+
-
+
-
Total Tax Paid Diesel Gallons Purchased According To Date:
Page of 2