Motor Fuel Schedule Of Receipts Form - Iowa Department Of Revenue
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1
2Iowa Department of Revenue
Schedule of Receipts
81-018a (7/27/06)
Company Name
License Number FEIN:
Schedule Code:
Product Code:
Month/Year
Schedule Code:
Product Code (list in box above) Only one product per schedule.
1A Gallons received originating state tax-paid.
2X Gallons received from suppliers on
065 Gasoline
130 Jet Fuel
079 E85
142 Kerosene - undyed
1G Gallons received fully taxed at a reduced
exchange agreements tax unpaid.
123 Alcohol
161 Low Sulfur Diesel #1-undyed
rate (for blending).
3
Gallons imported from another state
124 Gasohol
167 Low Sulfur Diesel # 2 - undyed
2
Gallons received from motor fuel licensee
direct to customer.
125 Aviation Gasoline
284 Bio-diesel undyed (B-100)
tax unpaid.
3A Gallons imported from terminals/
226 High Sulfur Diesel Fuel - dye added
285 Soy Oil
2A Gallons received from terminals, refineries
refineries.
227 Low Sulfur Diesel Fuel - dye added
___Other (see FTA Product Code List)
or distributors, origin tax-unpaid.
3B Gallons imported from bulk storage
2B Gallons received tax-unpaid, blendable
in another state.
stock.
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Point Of
Acquired
Seller
Date
Bills Of
Carrier Name
Carrier FEIN
Mode
Origin
Dest.
From
FEIN
Received
Lading
Gross Gallons
Totals:
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