Schedule Df-1b - Diesel Fuel / Propane / Natural Gas Distribution Schedule Df-1b
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1Year of
Instructions
Use this form to prepare Schedules 9,
Month of
10, 11, 12, 16 and 22.
Prepare a separate form for each
Name of Licensed Distributor
Schedule Number
schedule required.
Connecticut Tax Registration Number
Title of Schedule
Insert schedule number and title in the
spaces provided.
Point of
Date
Sold To
Method of Delivery
Type of Fuel
Shipment
Delivery
Gallons
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(Transfer this total to appropriate line of Diesel Fuel / Propane / Natural Gas Tax Return, Form OP-216)
Indicate type of fuel, i.e., diesel, propane, natural gas or kerosene blended with diesel fuel.
DF-1B (Rev. 11/97)
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