Motor Fuel Supplier Schedule Of State Diversion Corrections Form - North Carolina Department Of Revenue

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Motor Fuel Supplier Schedule of State Diversion Corrections
Gas-1202DC
Web
North Carolina Department of Revenue
File with GAS-1202
1-04
Schedule
Product
Legal Name (First 35 Characters) (USE CAPITAL LETTERS FOR YOUR NAME)
Account Number
Type
Type
Month
Year
-
11
Product Type
065 Gasoline
124 Gasohol
160 Diesel - Undyed
243 Methanol
072 Kerosene - Dyed
125 Aviation Gasoline
226 Diesel - High Sulfur Dyed
284 Biodiesel - Undyed
122 Blending Components
130 Jet Fuel
227 Diesel - Low Sulfur Dyed
290 Biodiesel - Dyed
241 Ethanol
123 Alcohol
142 Kerosene - Undyed
(4)
(1)
(2)
(5)
(6)
(7)
(8)
(9)
(12)
(13)
Carrier
Carrier
Terminal Control
Purchaser
Purchaser
Date
Document
Billed
Diversion
Original
Revised
Name
FEIN
Number
Name
FEIN
Shipped
Number
Gallons
Number
Dest. St.
Dest. St.
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5
TOTAL
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5

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