Form Pt-103.1 - Residual Petroleum Product - Receipts And Sales

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New York State Department of Taxation and Finance
PT-103.1
Residual Petroleum Product - Receipts and Sales
(3/01)
Read instructions (Form PT-103-I) carefully. Keep a copy of this completed form for your records.
Name of petroleum business
FEIN
Month/year
Part I - Receipts in New York State from sources outside this state
Seller’s
Date
Gallons
Name
Address
FEIN
(city and state/province)
Total gallons
.........................................................................................................
(enter here and on Form PT-103, line 2)
Part II - Receipts in New York State from sources within this state
Seller’s
Date
Gallons
Name
Address
(city and street)
FEIN
Total gallons
.........................................................................................................
(enter here and on Form PT-103, line 3)
Part III - Other receipts
Seller’s
Date
Gallons
Name
Address
FEIN
(city and state/province)
Total gallons
.........................................................................................................
(enter here and on Form PT-103, line 4)

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