Form Sf-401 - Transporter'S Schedule Of Deliveries - Indiana

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SF-401
SF# 46287
Indiana Department of Revenue
(R2/05-07)
Transporter's
Monthly Tax Return
Due date is the 25th of the following month.
For the month of: ____________ 20______
Name of License Holder (As indicated on License)
Mailing Address (Street or P.O. Box Number)
City or Town
State
Zip Code
Telephone Number
License Number
Federal Identifi cation Number
Motor Carrier/IFTA Number
Net Gallons
From
Column A
Column B
Column C
Other Products
Schedule
Special Fuel
Gasoline
(Jet Fuel,
(Dyed and Clear
(Gasoline,
Kerosene)
Diesel Fuel, Biodiesel
Gasohol)
and Blended
Biodiesel)
1. Total gallons of fuel loaded from an Indiana
terminal or bulk plant and delivered to another state.
1A
2. Total gallons of fuel loaded from an out-of-state
terminal or bulk plant and delivered into Indiana.
2A
3. Total gallons of fuel loaded from an Indiana
terminal or bulk plant and delivered within Indiana.
3A
4. Total gallons of fuel transported
(Add lines 1, 2, and 3).
Transporter's Schedule of Deliveries
Schedules 1A, 2A and 3A must be attached to this report
Mail Return To:
Indiana Department of Revenue, P.O. Box 6080, Indianapolis, IN 46206-6080
Under penalty of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best
of my knowledge and belief it is true, correct, and complete. I further declare that complete and proper records are on fi le at the ad-
dress indicated above for all fuel reported on this return.
Taxpayer or Authorized Agent
Typed or Printed Name
Title
Date Signed
Telephone Number
(
)
Important! A return must be fi led each month, within 25 days following the last day of the month being reported.
Failure to submit this report could result in a civil penalty of $1,000 for each violation.

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