Schedule 82-010 - Transport Diversions To Points Outside Iowa (Page 2 of 2) in pdf

Schedule 82-010 - Transport Diversions To Points Outside Iowa Page 2

I O WA

Transport Diversions to points outside Iowa

d e p a r t m e n t o f R e v e n u e a n d F i n a n c e

Send this claim to: Iowa Dept. of Revenue &

Schedule 82-010 (02/98)

Name of

Finance

Claimant ______________________

Motor Fuel Unit

Attach to Form 82-006

Examination Section

P.O. Box 10456

FEIN _________________________

Des Moines, IA 50306-0456

City and State of terminal location

Bill of lading

Bill of lading no. Number of gallons Type of fuel

Name of terminal operator

date

Originally consigned/sold to

City and State of original destination

Name of supplier

Name of carrier hauling product

Company/Person diverted to

City and State of delivery point

Are you registered to report fuel

If YES, list registration number in

tax in state where product was

other state.

delivered?

o Y E S

o N O

Explain reason for diversion and how tax is being reported in state where product was diverted.

To receive the refund, the person must complete and file this

form with supporting documentation. Supporting documents

include a copy of the bill of lading (manifest), invoices or

documents showing where and to whom the fuel was delivered, a

copy of the reporting form and evidence of payment to the state

where the fuel was actually delivered.

Terminal operator

Supplier

Schedule 82-010 - Transport Diversions To Points Outside Iowa Page 2