Form Rv-F1402101 - Unlicensed Exporter Claim For Refund - Tennessee Department Of Revenue Page 2
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3Schedule A - Purchases of Tennessee Tax Paid Gallons - Unlicensed Exporter Claim for Refund (Attach to PET 380)
Exporter Name:
FEIN:
Account Number:
Month of (MM-YY):
Tennessee Department of Revenue
Product Type (Circle One)
65 GASOLINE
142 KEROSENE
M O D E
122 BLENDING COMPONENTS (TRANSMIX)
160 UNDYED DIESEL
J TRUCK
123 ALCOHOL
226 DIESEL (HIGH SULFUR DYED)
R RAIL
124 GASOHOL
227 DIESEL (LOW SULFUR DYED)
B BARGE
125 AVIATION GASOLINE
____ OTHER (SEE ITA PRODUCT CODE LIST)
PL PIPELINE
130 JET FUEL
B A BOOK ADJUSTMENT
ST STOCK TRANSFER
POINT OF
TERMINAL
PURCHASED
SHIPPING
CARRIER
SHIP
SALES
TAX PAID
CODE #
FROM
PAPER
CARRIER NAME
FEIN
MODE
ORIGIN
DESTINATION
DATE
DOCUMENT #
GALLONS
Schedule Instructions - Use this schedule to provide detailed information to support Line 1 of the return. A separate schedule is required for each product type.
Total Gallons
RV-F1402001
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Parent category: Financial