Form Pt -102.1 - Diesel Motor Fuel Receipts And Nontaxable Sales (Page 2 of 2) in pdf

Form Pt -102.1 - Diesel Motor Fuel Receipts And Nontaxable Sales Page 2

PT-102.1 (3/01) (back)

Name of distributor

FEIN

Month/year

Part IV – Sales to exempt organizations

(l ist sales (except sales for residential heating/cooling) to exempt organizations

qualified under sections 1116(a)(4) or 1116(a)(5) of the Tax Law; this exemption is for sales of unenhanced diesel motor fuel

only)

Date

Name and address of exempt organization

Exempt

Gallons for

Gallons for purposes

organization number

nonresidential

other than heating

heating

(except on the

highway) but in the

furtherance of the

organization’s

exempt purposes

1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9

Total nonresidential heating gallons

(enter here and on Form PT-102, line 11) ..................................

1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9

Total other gallons

(enter here and on Form PT-102, line 29) ............................................................................................................

Part V – Exempt sales on Indian reservations

(include sales to exempt Indian nations or tribes and qualified Indian consumers;

see instructions)

Name and address of

Exempt

Product

Date

FEIN

Gallons

purchaser

organization number

type *

Total gallons

(enter here and on Form PT-102, line 19) .............................................................................................................................

Part VI – Sales to the United States government, New York State and municipalities

Product

Date

Name of governmental entity

Contract or approval number

Gallons

type*

Total gallons

(enter here and on Form PT-102, line 20) .......................................................................................................................

*Product Type: 1 - Kerosene; 2 - No. 2 fuel oil; 3 - Diesel fuel, No. 1 diesel fuel, No. 2 diesel fuel, and enhanced No. 2 fuel oil;

4 - No. 4 fuel oil; 5 - Kero-jet fuel; 6 - Other.