Form Wv/mft-507 A - Motor Fuel Transporter Schedule Of Deliveries - Schedule Number 1 Page 2
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1
2INSTRUCTIONS
This schedule provides detail in support of the transportation amount(s) shown on your monthly West Virginia Motor Fuel Transporter Report (WV/GAS-
507). Upon prior approval, you may submit a schedule summarizing your delivery schedules which must be formatted the same as the West Virginia Motor
Fuel Transporter Schedule of Deliveries (WV/GAS-507A). If you choose to submit summary schedules, you must still submit the schedules of individual
deliveries.
Complete Separate Schedules for Each Product Type and point of origin. Group Purchasers Together.
FEIN/SSN
Enter the FEIN or SSN as shown on your monthly West Virginia Motor Fuel Transporter Report.
Name
Enter the name as shown on your monthly West Virginia Motor Fuel Transporter 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.
Hiring Company – Name
Enter the Name of the Company that hired you to transport the product.
Hiring Company – FEIN/SSN
Enter the FEIN or SSN of the company that hired you to transport the product.
Seller – Name
Enter the Name of the Company from whose account the product was withdrawn at the terminal or bulk plant.
Seller – FEIN/SSN
Enter the FEIN or SSN of the Company from whose account product was withdrawn at the terminal or bulk plant.
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 shipped from a terminal.
Otherwise, enter the City and State where the shipment originated.
Delivered to – Name
Enter the name of the company to whom you delivered the product.
Delivered to – Address
Enter the IRS Terminal Control Number if the product was delivered to a terminal.
Otherwise, enter the City and State where the product was delivered.
Delivered to – FEIN/SSN
Enter the FEIN or SSN of the company to whom you delivered the product.
Date Delivered
Enter the date (Month, Day, Year) the product was delivered.
Document Number
Enter the Terminal Manifest Number, Barge Ticket Number, Or Bulk Plant Withdrawal Invoice Number.
Gross Gallons
Enter the Gross Gallons you delivered.
Net Gallons
Enter the Net Gallons you delivered.
Sub Total
Enter the Total of Columns 12 and 13 for this page of the report.
Grand Total
Enter the Grand-Total of Columns 12 and 13 for all pages of this report.
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