Form 1536 - Transporter Report Of Deliveries - 2016
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Document Locator Number
Missouri Department of Revenue
Form
1536
Transporter Report of Deliveries
Page _______ of _______
Company Name
License Number
Schedule Type
Federal Employer I.D. Number
Month and Year
__ __ /__ __ __ __
Select One
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1A. Total all deliveries of fuel from in-state locations to out of state
065 - Gasoline
125 - Aviation Gasoline
160 - Clear Diesel Fuel
290 - Bio-Diesel - Dyed B100
locations (exports)
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123 - Alcohol
130 - Jet Fuel
228 - Dyed Diesel Fuel
225 - Liquefied Natural Gas (LNG)
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2A. Total all deliveries of fuel from out-of-state locations to in-state
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241 - Ethanol
142 - Clear Kerosene
284 - Bio-Diesel - Undyed B100
122 - Blending Components
locations (imports)
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(Identify) ___________
3A. Totals all deliveries of fuel between points in the state (intrastate)
124 - Gasohol
072 - Dyed Kerosene
285 - Soy Oil
Person Hiring the Carrier
Seller
Delivered To
Gallons
Date
Document
Mode
Origin
Delivered
Federal I.D.
Federal I.D.
Federal I.D.
Number
Address
Company Name
Company Name
Name
Net
Gross
(MM/DD/YYYY)
Number
Number
Number
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Mail to: Taxation Division
Phone: (573) 751-2611
Page Total
P.O. Box 300
Fax: (573) 522-1720
Jefferson City, MO 65105-0300
TTY: (800) 735-2966
Visit
Schedule Total
E-mail:
excise@dor.mo.gov
for additional information.
Form 1536 (Revised 01-2016)
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Parent category: Financial