Form Wv/mft-508 D - Importer Schedule Of Diversions - 2004
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1WV/MFT-508 B
IMPORTER SCHEDULE OF TAX-UNPAID RECEIPTS
REV 11/04
WEST VIRGINIA STATE TAX DEPARTMENT
INTERNAL AUDITING DIVISION
P O BOX 2991
J
Charleston, WV 25330-2991
(304) 558-8623; (304) 558-8624; (304) 558-8625; (304) 558-8626; (304) 558-8627
YOU MUST COMPLETE SEPARATE SCHEDULES FOR EACH PRODUCT TYPE AND SELLER
FEIN
NAME
MONTH/YEAR
SCHEDULE 2
PRODUCT INFORMATION (CHECK APPLICABLE BOX)
MODE OF TRANSPORTATION
□ 150 – #1 Fuel Oil
□ 228 – Diesel – Dyed
□ 054 – Propane
J – Truck
□ 125 – Aviation Gasoline
□ 160 – Diesel – Undyed
□ 224 – Compressed Natural Gas
R – Rail
□ 130 – Aviation Jet Fuel
□ 284 – Biodiesel – Undyed
□ 225 – Liquefied Natural Gas
B - Barge
□ 122 – Blending Components
□ 072 – Kerosene – Dyed
□ Other – Product Type ___________
□ 124 – Gasohol
□ 142 – Kerosene – Undyed
Product Code __________
□ 065 – Gasoline
PRODUCT RECEIPT INFORMATION
(1)
(2)
(3)
(4)
(5)
(7)
(8)
(9)
(10)
(11)
(12)
(6)
Mode
Point of
Date
Bill of
Gross
Net
INVOICED
Import
Transporte
Transporter
Seller
r
Seller
Origin
Destination
Received
Lading
GALLONS
Confirmation
Gallons
Gallons
Name
FEIN
Name
FEIN
Number
Number
IMPORTANT NOTICE
:
TOTAL THIS PAGE
You must obtain prior approval to submit your own schedules
TOTAL ALL PAGES INVOICED GALLONS ONLY
BY PRODUCT TYPE – Transfer to Line 1 of Report
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Parent category: Financial