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Form Pt-106.1-201.1 - Retailers Of Non-Highway Diesel Motor Fuel Only - Receipts And Sales

PT-106.1/201.1

New York State Department of Taxation and Finance

Retailers of Non-Highway Diesel Motor Fuel Only -

(9/11)

Receipts and Sales

Read instructions carefully. Keep a copy of this completed form for your records.

Name of distributor

Federal employer identification number (EIN) Month/year or quarterly period

Part 1 - Receipts of non-highway diesel motor fuel in New York State from sources outside this state

For each out-of-state supplier from whom you imported non-highway diesel motor fuel, enter the (1) date (various receipts during the period

may be reported on one line without the date entry), (2) supplier’s name and address, (3) supplier’s EIN, (4) code for each product type, and

(5) total gallons of each product type that you imported during the period. If non-highway diesel motor fuel has been imported from your own

out-of-state facilities during the period, enter the name and address of each facility, the code for each product type, and the total gallons of

each product type. Include all gallons shipped directly to any of your facilities or customers in New York State.

Date

Name and address of supplier

EIN

Product

Gallons

Code*

Total gallons

(enter here and on line 2, of either Form PT-106, for monthly filers, or Form PT-201,

.........................................................................................................................................

for quarterly filers)

Part 2 - Receipts of non-highway diesel motor fuel in New York State from sources within this state

For each supplier from whom you purchased or received non-highway diesel motor fuel in New York State, enter the (1) date (various

receipts during the period may be reported on one line without the date entry), (2) supplier’s name, (3) supplier’s EIN, (4) code for each product

type, and (5) total gallons of each product type that you purchased or received untaxed (for which you provided a completed Form FT-1001).

Include all gallons shipped directly to any of your facilities or customers in New York State.