Form Sf# 49081 - Schedules 1 Through 4 Schedule Of Receipts Form 2005-2007
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1
2Schedules 1 through 4
SF# 49081
Schedule of Receipts
(R2/05-07)
Company Name
License Number
Month / Year
FEIN
You may photocopy this blank schedule for future fi lings. Attach additional sheets as necessary.
Product Code/Type (Check One)
Schedule Type (Check One)
For Use with Reporting Special Fuel
For Use with Reporting Gasoline/Oil Inspection
1
Gallons Received, Tax Paid, (Special Fuel Returns Only)
142
Kerosene
065
Gasoline
1A Gallons Received, Tax Paid (Gasoline Return Only)
160
Diesel Fuel - clear
124
Gasohol
2
Gallons Received from Licensed Distributor or Oil Inspection Distributor, Tax Unpaid
170
Biodiesel - undyed (blended product)
125
Aviation Fuel
(Gasoline Only)
171
Biodiesel - dyed (blended product)
130
Jet Fuel
228
Diesel Fuel - dyed
142
Kerosene
2E Gallons Received for Export (Special Fuel Exporter Only)
B00
Biodiesel (B-100) - undyed
150
#1 Fuel Oil - undyed
2K Gallons of Non-Taxable Fuel Received and Sold or Used for a Taxable Purpose
D00
Biodiesel (B-100) - dyed
161
Low Sulfur Diesel #1 - undyed
2X Gallons Received from Distributor on Exchange (Gasoline Only)
OTH
Other (specify)
231
No. 1 Diesel - dyed
3
Gallons Imported Via Truck, Barge, or Rail, Tax Unpaid
167
Low Sulfur Diesel #2 - undyed
E00
Ethanol - (100%)
4
Gallons Imported into Own Storage (Gasoline Only)
161
Low Sulfur Diesel #1 - undyed
E85
85% Ethanol / 15% Gasoline
M00
Methanol - (100%)
OTH
Other (specify)
Transporter Information
(4)
Purchased From Information
(1)
(2)
(3)
Point of
(5)
(6)
(7)
(9)
(10)
(11)
(8)
Net
Name
FEIN
Mode
Name
FEIN
Date
Document
Gross
Billed
Origin
Dest.
Received
Number
Gallons
Gallons
Gallons
(State)
(State)
Total
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