Form 72a156 - Report Of Special Fuels Sold To Licensed Kentucky Dealers

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72A156 (10-06)
REPORT OF SPECIAL FUELS
Commonwealth of Kentucky
DEPARTMENT OF REVENUE
SOLD TO LICENSED KENTUCKY DEALERS
Tax Paid by Consignee
Name and Address of Dealer
INSTRUCTIONS: This report must be completed by all licensed
Report for Month of ___________________ , 20___
special fuels dealers who have sold fuel to other licensed Kentucky
special fuels dealers. Use a separate line for each shipment. File a
separate report for each consignee (purchaser). Complete this report
Date Report Prepared _________________ , 20____
in duplicate and attach both copies to Form 72A138.
Truck No.
Name and Address
Invoice
Date of
Gallons
Carrier
Origin
Destination
Car Initial and No.
of Consignee
Number
Shipment
Shipped
Barge No.
TOTAL*
*Total sales to Kentucky dealers must equal line 7, Form 72A138.

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Parent category: Financial
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