Form Pt-101.6 - Sales In New York State With The Motor Fuel Tax Passed Through 2001

PT-101.6

New York State Department of Taxation and Finance

Sales in New York State with the Motor Fuel Tax Passed Through

(3/01)

Read instructions (Form PT-101-I) carefully. Keep a copy of this completed form for your records.

Name of distributor

FEIN

Month/year

Part I — Sales or use of motor fuel

(not including LPG or CNG – see Parts II and III on back)

Mode

Carrier’s name

Purchaser’s name

City and state, point of:

Date

of

and

and

shipped

delivery

FEIN

FEIN

Origin

Destination

Gallons

Total gallons ........................................................................................................................................................................................................................