Form Wv/mft-511c - Exporter Schedule Of Diversions Into West Virginia

Form Wv/mft-511c - Exporter Schedule Of Diversions Into West Virginia - 2003 Page 2

INSTRUCTIONS

This schedule provides detail in support of the diversions amount(s) shown on your monthly West Virginia Exporter Report (WV/GAS-511). Upon prior

approval, you may submit a schedule summarizing your diversions schedules, which must be formatted the same as the West Virginia Exporter Schedule

of Diversions into West Virginia (WV/GAS-511C). If you choose to submit summary schedules, you must still submit the schedules of individual

diversions.

Complete Separate Schedules for Each Product Type

FEIN/SSN

Enter the Federal Employment Identification Number (FEIN) or

Social Security Number (SSN) as shown on your monthly West Virginia Exporter Report.

Name

Enter the Name of the Company as shown on your monthly West Virginia Exporter Report.

Report Month/Year

Enter the Month and Year you are reporting.

Product Information

Check the applicable box for the product type accounted for on this schedule.

Motor Fuel Transporter’s Name

Enter the Name of the Company that transported the product.

Motor Fuel Transporter’s FEIN/SSN

Enter the FEIN or SSN of the company that transported the product.

Mode

Enter the code for the mode of transport used to move the product (see Mode of Transportation Codes on the front).

Point of Origin

Enter the IRS Terminal Control Number if the product was received from a terminal.

Otherwise, enter the City and State where the shipment originated.

Point of Destination

Enter the City and State where the product was delivered.

Purchaser’s Name

Enter the Name of the Company that purchased the product.

Purchaser’s FEIN/SSN

Enter the FEIN or SSN of the company that purchased the product.

Date Received

Enter the date (Month, Day, Year) the product was received.

Document Number

Enter the Terminal Manifest Number or Bulk Plant Withdrawal Invoice Number.

Gross Gallons

Enter the Gross Gallons you delivered.

Net Gallons

Enter the Net Gallons you delivered.

Billed Gallons

Enter the total number of Gallons Billed.

Diversion Number

Enter the Number issued by the National Fuel Diversion Registry that authorized the diversion of the product

Form Wv/mft-511c - Exporter Schedule Of Diversions Into West Virginia - 2003 Page 2