Form Pt-101.3 - Transfers And Sales Of Motor Fuel Outside New York State - New York State Department Of Taxation And Finance
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1
2PT-101.3
New York State Department of Taxation and Finance
Transfers and Sales of Motor Fuel Outside New York State
(3/01)
Read instructions (Form PT-101-I) carefully. Keep a copy of this completed form for your records.
Name of distributor
FEIN
Month/year
Submit in duplicate. Use a separate sheet for each state and province. To the state or province of:
Part I — Transfers out of New York State
Mode
Carrier’s name
Customer’s name
City and state, point of:
Date
of
and
and
Gallons
shipped
delivery
FEIN
FEIN
transferred
Origin
Destination
Total gallons (enter here and on Form PT-101, line 10)
..............................................................................................................................................................
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