State Form 49085 - Schedule 11 - Schedule Of State Diversion Corrections
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1
2Schedule 11
State Form 49085
10-03
Schedule of State Diversion Corrections
Supplier Name
License Number
Month / Year
FEIN
You may photocopy this blank schedule for future filings. Attach additional sheets as necessary.
Product Code/Type (Check One)
For Use with Reporting Special Fuel
For Use with Reporting Gasoline/Oil Inspection
142
Kerosene
065
Gasoline
161
Low Sulphur Diesel #1 - undyed
124
Gasohol
167
Low Sulphur Diesel #2 - undyed
125
Aviation Gasoline
226
High Sulphur Diesel - dye added
130
Jet FuelGasoline
227
Low Sulphur Diesel - dye added
142
Kerosene
228
Diesel/Fuel Oil Dyed - dye added
150
#1 Fuel Oil - undyed
231
No. 1 Diesel - dye added
161
Low Sulphur Diesel #1 - undyed
284
Biodiesel - undyed
231
No. 1 Diesel - dye added
290
Biodiesel - dye added
241
Ethanol
OTH
Other
243
Methanol
282
#1 High Sulphur Diesel - undyed
OTH
Other
(4)
(5)
(1)
(2)
(3)
Original
Revised
(6)
(7)
(8)
(9)
(10)
(11)
(12)
(13)
Terminal
Carrier
Carrier
Mode
Dest.
Dest.
Purchaser
Date
Document
Net
Gross
Billed
Diversion
Purchaser
Name
FEIN
State
Code
Name
Shipped
Number
Gallons
Gallons
Gallons
Number
State
FEIN
Total
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