Schedule Df-1b - Diesel Fuel/propane/natural Gas - Department Of Revenue Services - State Of Connecticut
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1Department of Revenue Services
Receipts Record
State of Connecticut
Schedule DF-1B
(Rev. 08/03)
Month of
Diesel Fuel / Propane / Natural Gas
Name of Licensed Distributor
Applicable Line Number on
Form OP-216
Connecticut Tax Registration Number
Instructions
• Use this schedule to provide data for completing Lines 9, 10, 11, 16, and 22 on Form OP-216,
Diesel Fuel / Propane / Natural Gas Tax Return .
• Prepare a separate schedule for each line as required.
• Insert applicable line number in the space provided on this schedule.
• Attach completed schedule to Form OP-216.
Point of
Gallons
(Round to nearest
whole gallon)
Date
Sold To
Method of Delivery *Type of Fuel
Shipment
Delivery
(1)
(2)
(3)
(4)
(5)
(6)
(7)
Total Gallons
(Transfer this total to the appropriate line on Form OP-216, Diesel Fuel / Propane / Natural Gas Tax Return )
* Indicate type of fuel, such as, diesel fuel, #2 fuel oil, propane, natural gas, or kerosene blended with diesel fuel.
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