MT-903-MN Highway Use Tax Return

1 Please make a copy for your records MT-903-MN (5/15) MT-903-MN Highway Use Tax ReturnUS DOT #Read the instructions(Form MT-903-I)before fillingout this : Make your check or money order payable in funds to:COMMISSIONER OF TAXATION AND FINANCEW rite your taxpayer ID number,MT-903, and the period covered by thisreturn on your check or money payment amount..Mark anXin the box if you hadno activityin New York State for this period, and enter"0"on line 3 below. No further entriesare necessary; complete theCertificationsection below and thetotal taxable milestraveled in New York State for this period by all vehicles.

2 Enter thetotal miles (including Thruway miles) traveled in New York Statefor this period by all vehiclesMark anXin the box to indicate filing method, which cannotbe changed during the calendar year:gross weight methodunloaded weight methodIfnohighway use tax is due for this period, mark anXin one of theboxes below or enter"0"on line miles reported by another (leased motor vehicles)All motor vehicles are exempt (example: crane, mail, householdgoods, etc.)93115194 NameNumber and street or PO boxCity, state, ZIP codeTaxpayer ID numberPeriod covered:Begin date(mm/dd/yy)End date(mm/dd/yy)Due date(mm/dd/yy)Change of business information -You can update your addressand other business information by visiting our W eb site (seeNeedhelp?)

3 In Form MT-903-I). Select the option to change youraddress for further instructions. For more information, seeChange of business informationin the Highway use tax schedule totals(First completeSchedule 1orSchedule 2, or both, on back page and then enter final totals in boxes 1a and 1b below.)Schedule 1 total taxSchedule 2 total taxTotal Highway use tax(add 1a and 1b) Highway use tax overpayments to be applied(attach a copy of Form MT-927)Note: Fuel use tax credits cannot be used to reduce Highway use tax .. Highway use tax due(subtract line 2 from line 1c) .. filing penalty (see instructions).

4 Filing interest (see instructions) .. Highway use tax due(add lines 3, 4, and 5) .. :I certify that this Return and any attachments are to the best of my knowledge and belief true, correct, and 's signatureOfficial titleTelephone number()Taxpayer's email addressPaid preparer's email addressDatePrint name of paid individual or firm preparing this Return Signature of individual preparing this Return Paid preparer's telephone number()Paid preparer's ID numberPaid preparer's mailing addressFor office use onlyPreparer's NYTPRINNYTPRIN excl. codeTo compute the tax due on the schedules below, see theTax rate tables for Highway use taxon page 4 of Form MT-903-I,Instructions for Form sure to use the proper tables for your reporting method.

5 If you have any questions, please seeNeed help?in Form use tax - Schedule 1Do not report Thruway mileage or vehicles required to be included in Schedule informationLadenUnladenABCP ermit # orGrossUnloadedcertificate #weightweightDEFT axable miles inRateTaxNew York State(see instructions)(D x E)GHIT axable miles inRateTaxNew York State(see instructions)(G x H)If you need additional lines,photocopy this page or attachcomputer use tax - Schedule 2 Complete this schedule only if you operate 3 or fewer vehicles per month hauling certain timber products or bulk raw milk.

6 If you operate more than 3 suchvehicles, do not completeSchedule 2; list all the vehicles inSchedule 1(see instructions).Do not report Thruway mileage or vehicles required to be included in Schedule informationLadenUnladenJKLP ermit # orGrossUnloadedcertificate #weightweightMNOT axable miles inRateTaxNew York State(see instructions)(M x N)PQRT axable miles inRateTaxNew York State(see instructions)(P x Q)Attach computer printouts if mailing instructions, seeWhere to filein Form Total of columnF8. Total from attached schedule(s)9. Subtotal (add lines 7 and 8)10. Total of columnI11.

7 Total from attached schedule(s)12. Subtotal (add lines 10 and 11)13. Enter line 9 amount 1 total tax(add lines 12 and 13; enter the result here and online 1aon the front page)15. Total of columnO16. Total from attached schedule(s)17. Subtotal (add lines 15 and 16)18. Total of columnR19. Total from attached schedule(s)20. Subtotal (add lines 18 and 19)21. Enter line 17 amount 2 total tax(add lines 20 and 21; enter the result here and online 1bon the front page)Page 2 of 2MT-903-MN(5/15)93215194