Form Wv/mft-508 E - Importer Schedule Of Diversions - 2004
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1IMPORTER SCHEDULE OF DIVERSIONS
FROM WEST VIRGINIA TO ANOTHER STATE
WV/MFT-508 E
REV 11/04
WEST VIRGINIA STATE TAX DEPARTMENT
INTERNAL AUDITING DIVISION
J
P O BOX 2991
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 PURCHASER
FEIN
NAME
MONTH/YEAR
SCHEDULE
11A
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)
Transporter
Transporter
Mode
Point of
Purchaser
Date
Bill of
Gross
Net
INVOICED
Diversion
Purchaser FEIN
Origin
Destination
Loaded
Lading
Gallons
Gallons
GALLONS
Number
Name
FEIN
Name
Number
IMPORTANT NOTICE: YOU MUST OBTAIN PRIOR APPROVAL TO SUBMIT YOUR OWN SCHEDULES
TOTAL THIS PAGE
TOTAL ALL PAGES INVOICED GALLONS ONLY
BY PRODUCT TYPE - TRANSFER TO LINE 3 AND 5 OF REPORT
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