Form Tc-364a - Special Fuel Supplier Schedule Of Receipts

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Special Fuel Supplier Schedule of Receipts
TC-364A Rev. 7/97
Company name
Account number
FEIN
Schedule type
Month/Year
Schedule Types
Check Product Types
Gallons received Utah tax paid
122 Blend components (includes transmix)
175 Residual fuel oil
1.
(Enter on lines 6 and 12, TC-364)
226 High sulfur diesel fuel - dye added
142 Kerosene
Gallons of dyed diesel received
2a.
(Enter on line 3, TC-364)
227 Low sulfur diesel fuel - dye added
160 Diesel fuel - undyed
Gallons received on exchange
2b.
(Enter on line 7, TC-364)
161 Low sulfur diesel #1 - undyed
228 #1 Diesel - dye added
Gallons of blend product
2c.
(Enter on line 4, TC-364)
167 Low sulfur diesel #2 - undyed
Gallons imported from state of ________
3.
150 #1 Fuel oil - undyed
(Enter on line 5, TC-364)
Document number
Net
Gross
Billed
Carrier name
Mode
Point of origin
Destination
Seller's name
Seller's FEIN
Date shipped
Invoice number
Bill-of-lading
gallons
gallons
gallons
TOTALS
T364A.FRM

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Parent category: Business
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