Please make a copy for your records
MT-903-MN (5/15)
MT-903-MN Highway Use Tax Return
US DOT #
Read the instructions
(Form MT-903-I) before filling
out this return.
Payment: Make your check or money order payable in U.S. funds to:
COMMISSIONER OF TAXATION AND FINANCE
Write your taxpayer ID number, MT-903, and the period covered by this
return on your check or money order. Enter payment amount . . .
Mark an X in the box if you had no activity in New York State for this period, and enter "0" on line 3 below. No further entries
are necessary; complete the Certification section below and mail.
Enter the total taxable miles traveled in New York State for this period by all vehicles .................................
Enter the total miles (including Thruway miles) traveled in New York State for this period by all vehicles
Mark an X in the box to indicate filing method, which cannot
be changed during the calendar year:
gross weight method unloaded weight method
If no highway use tax is due for this period, mark an X in one of the
boxes below or enter "0" on line 3.
All miles reported by another (leased motor vehicles)
All motor vehicles are exempt (example: crane, mail, household
goods, etc.)
93115194
Name
Number and street or PO box
City, state, ZIP code
Taxpayer ID number
Period covered:
Begin date
(mm/dd/yy)
End date
(mm/dd/yy)
Due date (mm/dd/yy)
Change of business information - You can update your address
and other business information by visiting our Web site (see Need
help? in Form MT-903-I). Select the option to change your
address for further instructions. For more information, see
Change of business information in the instructions.
1. Highway use tax schedule totals (First complete Schedule 1 or Schedule 2, or both, on back page and then enter final totals in boxes 1a and 1b below.)
Schedule 1 total tax Schedule 2 total tax Total highway use tax (add 1a and 1b)
1a.
1b.
..........................
1c.
.
2.
Prior 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 ...................................
2.
.
3. Highway use tax due (subtract line 2 from line 1c) .................................................................. 3.
.
4. Late filing penalty (see instructions) ......................................................................................... 4.
.
5. Late filing interest (see instructions) ......................................................................................... 5.
.
6. Highway use tax due (add lines 3, 4, and 5) ........................................................................... 6.
.
Certification: I certify that this return and any attachments are to the best of my knowledge and belief true, correct, and complete.
Date Taxpayer's signature Official title Telephone number
( )
Taxpayer's email address Paid preparer's email address
Date Print name of paid individual or firm preparing this return Signature of individual preparing this return Paid preparer's telephone number
( )
Paid preparer's ID number Paid preparer's mailing address
For office use only
Preparer's NYTPRIN NYTPRIN excl. code
To compute the tax due on the schedules below, see the Tax rate tables for highway use tax on page 4 of Form MT-903-I, Instructions for Form MT-903.
Be sure to use the proper tables for your reporting method. If you have any questions, please see Need help? in Form MT-903-I.
Highway use tax - Schedule 1 Do not report Thruway mileage or vehicles required to be included in Schedule 2.
Vehicle information Laden Unladen
A B C
Permit # or Gross Unloaded
certificate # weight weight
D E F
Taxable miles in Rate Tax
New York State (see instructions) (D x E)
G H I
Taxable miles in Rate Tax
New York State (see instructions) (G x H)
If you need additional lines,
photocopy this page or attach
computer printouts.
Highway 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. If you operate more than 3 such
vehicles, do not complete Schedule 2; list all the vehicles in Schedule 1 (see instructions).
Do not report Thruway mileage or vehicles required to be included in Schedule 1.
Vehicle information Laden Unladen
J K L
Permit # or Gross Unloaded
certificate # weight weight
M N O
Taxable miles in Rate Tax
New York State (see instructions) (M x N)
P Q R
Taxable miles in Rate Tax
New York State (see instructions) (P x Q)
Attach computer printouts if used.
For mailing instructions, see Where to file in Form MT-903-I.
7. Total of column F
8. Total from attached schedule(s)
9. Subtotal (add lines 7 and 8)
10. Total of column I
11. Total from attached schedule(s)
12. Subtotal (add lines 10 and 11)
13. Enter line 9 amount here
14. Schedule 1 total tax (add lines 12 and 13; enter the result here and on line 1a on the front page)
15. Total of column O
16. Total from attached schedule(s)
17. Subtotal (add lines 15 and 16)
18. Total of column R
19. Total from attached schedule(s)
20. Subtotal (add lines 18 and 19)
21. Enter line 17 amount here
22. Schedule 2 total tax (add lines 20 and 21; enter the result here and on line 1b on the front page)
Page 2 of 2 MT-903-MN (5/15)
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