Form Sfn 22985 - Special Fuel Schedule Of Gallions Disbursed

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Special Fuel Schedule Of Gallons Disbursed
Tax Type 62
North Dakota Office Of State Tax Commissioner
SFN 22985 (7-2001)
Check if Amended Report
(Submit With Special Fuel Tax Report J01)
Business Name:
FEIN:
Suffix ND License No:
Reporting Period - Month and Year:
Disbursement Schedule Types - Check Only One
Product Types - Enter in Product Type Column
5 - Gallons Sold in North Dakota Tax Paid For Resale
72 - Kerosene - Dye Added
224 - Compressed Natural Gas (CNG)
6 - Gallons Sold in North Dakota Tax Free
142 - Kerosene - Undyed
228 - Diesel Fuel - Dye Added
7 - Gallons Exported by your Business to ________________ (see instructions)
160 - Diesel Fuel - Undyed
228 - Heating Fuel - Dye Added
8 - Gallons Sold to Agencies of the U.S. Government Tax Free (see instructions)
160 - Heating Fuel - Undyed
999 - Other _________________
10 - Gallons Sold to Native Americans Tax Free (see instructions).
For Biodiesel use 999 - Other (until further notice)
(2)
(5)
(9)
Inter-
(1)
Car.
(3)
(4) Point of
Sold to -
(6)
(7)
(8)
Net
(10)
Product Office
Carrier Name
ID
Mode
Origin
Destination
Purchaser Name
Purchaser FEIN
Date
Document No. Gal. Gross Gallons
Type
Use
Suffix
Total Gallons
Page _____

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