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Minnesota License Application for Distributors and Special Fuel Dealers
with TurboTaxExtracted from PDF file 2023-minnesota-form-pdo-100.pdf, last modified February 2015License Application for Distributors and Special Fuel Dealers
PDO-100 License Application for Distributors and Special Fuel Dealers New license application (include $25 license fee with application) Desired Start Date:___________________________ (Month/Year) Renewal of existing license must be completed electronically via e-Services at www.revenue.state.mn.us Legal Name Daytime Phone Doing Business As Federal ID Number Street County City State Minnesota Tax ID Number Email ZIP Code Fax Mailing Address (if different): Street City Type of Business Individual Partnership Corporation State Limited Liability Company (LLC) ZIP Code Governmental Agency List corporate officers, partners or members of association (attach a list for additional officers): Name Title Address Phone Accounting Information: Fuel Tax Preparer Name Phone Fax Address Email License Applied For: Distributor Qualifiers (check one): Receive petroleum products in Minnesota that are consigned to me from a terminal or refinery for storage and subsequent distribution by tank car or tank truck. Current petroex number and terminal: Produce, manufacture or refine petroleum products in Minnesota. Import petroleum products into Minnesota by boat, barge or pipeline for storage and subsequent delivery. Hold a license and perform a function in an adjoining state equivalent to that of a distributor under Minnesota law. Enter your license number for each state below Iowa South Dakota North Dakota Wisconsin Special Fuel Dealer Qualifiers (check one): State or Local Government LPG CNG/LNG Jet Fuel Bulk Purchaser. Individual users of tax-free special fuels. Filing Method (check one): Web and Text Files EDI Files — Software Provider ____________________________________________________________________________ Under the Minnesota Government Data Practices Act and the Federal Privacy Act of 1974, we must advise you of the following: • This information may be used to deny the issuance or renewal of your license if you owe the Minnesota Department of Revenue delinquent tax, penalties or interest. • Under the Federal Exchange of Information Act, the Department of Revenue is allowed to supply this information to the Internal Revenue Service. • Failing to supply this information may jeopardize or delay the issuance of your license or processing of your renewal application. I acknowledge that by becoming licensed as a petroleum distributor/special fuel dealer, I will have record keeping/reporting requirements and responsibilities. I agree to comply with the applicable tax statutes as a condition of my license, and declare that the information given in this application is true, correct and complete to the best of my knowledge and belief. Authorized Signature Title Date Mail this form to: Minnesota Revenue, Mail Station 3333, St. Paul, MN 55146-3333. Phone: 651-296-0889. (Rev. 1/22) Daytime Phone
PDO-100, License Application for Distributors and Special Fuel Dealers
More about the Minnesota Form PDO-100 Other TY 2023
We last updated the License Application for Distributors and Special Fuel Dealers in February 2024, so this is the latest version of Form PDO-100, fully updated for tax year 2023. You can download or print current or past-year PDFs of Form PDO-100 directly from TaxFormFinder. You can print other Minnesota tax forms here.
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Form Sources:
Minnesota usually releases forms for the current tax year between January and April. We last updated Minnesota Form PDO-100 from the Department of Revenue in February 2024.
Historical Past-Year Versions of Minnesota Form PDO-100
We have a total of three past-year versions of Form PDO-100 in the TaxFormFinder archives, including for the previous tax year. Download past year versions of this tax form as PDFs here:
2023 Form PDO-100
PDO-100, License Application for Distributors and Special Fuel Dealers
2022 Form PDO-100
PDO-100, License Application for Distributors and Special Fuel Dealers
2021 Form PDO-100
PDO-100, License Application for Distributors and Special Fuel Dealers
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